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General NPI Number Information
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NPI Number | 1063311744
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Entity Type | Individual
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Provider Name | ANGELA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 939 W NORTH AVE STE 600
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City | CHICAGO
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State | IL
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Zip | 60642-7138
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Country | US
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Telephone | 312-757-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 6937 COACHWOOD TRL
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City | TINLEY PARK
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State | IL
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Zip | 60477-6834
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Country | US
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Telephone | 708-601-1762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209036966
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License Number State | IL
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