Provider Demographics
NPI:1366780462
Name:ANDERSON, ANGELYN
Entity type:Individual
Prefix:
First Name:ANGELYN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5611
Mailing Address - Street 2:ATTN: ANGELYN M. ANDERSON
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680
Mailing Address - Country:US
Mailing Address - Phone:847-780-6466
Mailing Address - Fax:
Practice Address - Street 1:1604 W JUNEWAY TER
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1106
Practice Address - Country:US
Practice Address - Phone:847-780-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula