Healthcare Provider Details

I. General information

NPI: 1619426822
Provider Name (Legal Business Name): ANGELA K DUGO-MUNIZZI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA K. DUGO FNP-BC

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18225 TORRENCE AVE
LANSING IL
60438-2729
US

IV. Provider business mailing address

10646 S RIDGEWAY AVE
CHICAGO IL
60655-3804
US

V. Phone/Fax

Practice location:
  • Phone: 708-474-1061
  • Fax:
Mailing address:
  • Phone: 630-842-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.376211
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.000720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: