Healthcare Provider Details

I. General information

NPI: 1023406980
Provider Name (Legal Business Name): ANGELA JUNE KOSTNER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA DICRISTOFANO

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E DIVISION ST
DIAMOND IL
60416-6050
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-3500
  • Fax: 815-705-1718
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: