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General NPI Number Information
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NPI Number | 1992278196
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Entity Type | Individual
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Provider Name | DEANGELA ROBERSON SA
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 1212 N. LASALLE STE 100/ SURGERY CENTER
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City | CHICAGO
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State | IL
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Zip | 60610
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Country | US
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Telephone | 312-943-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 3580 SCHOOL DR
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-4986
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Country | US
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Telephone | 708-439-0652
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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