Healthcare Provider Details

I. General information

NPI: 1457695272
Provider Name (Legal Business Name): ANGELICA BELLISARIO APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR STE 103
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR STE 103
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8671
  • Fax: 815-756-4892
Mailing address:
  • Phone: 815-758-8671
  • Fax: 815-756-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002087
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209-009972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: