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General NPI Number Information
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NPI Number | 1265783070
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Entity Type | Individual
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Provider Name | ANGELA KRELO SURGICAL/MEDICAL AS
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Gender | Female
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 305 W. JACKSON SUITE 402
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-529-4711
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Fax | 618-998-8809
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Provider Business Mailing Address
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Address Line | 500 RUSHING DRIVE
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City | HERRIN
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State | IL
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Zip | 62948
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Country | US
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Telephone | 618-998-8808
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Fax | 618-998-8809
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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