Angela Rose Depa
Nurse Practitioner, Family in Long Grove, IL. Individual provider (NPI-1).
NPI number1194291237
StatusActive
Last updated in NPPESDec 20, 2021
Details
- NPI
- 1194291237
- Entity type
- Individual (NPI-1)
- Name
- Angela Rose Depa
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 16, 2018
- Certification date
- Dec 20, 2021
- Last updated
- Dec 20, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209018117 | IL | Yes |
Practice location
3880 Salem Lake Dr Ste FLong Grove, IL 60047-5292
Phone 847-719-2220 · Fax 847-719-2265
Mailing address
3880 Salem Lake Dr Ste FLong Grove, IL 60047-5292
Phone 847-719-2220 · Fax 847-719-2265
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