Healthcare Provider Details

I. General information

NPI: 1174212088
Provider Name (Legal Business Name): ANGELA QUIROZ APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9697 191ST ST
MOKENA IL
60448-8609
US

IV. Provider business mailing address

9697 191ST ST
MOKENA IL
60448-8609
US

V. Phone/Fax

Practice location:
  • Phone: 630-305-5027
  • Fax:
Mailing address:
  • Phone: 630-305-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027186
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.027186
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: