Provider Demographics
NPI:1730928052
Name:POOTHURAIL, ANGELA ALPHONSA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ALPHONSA
Last Name:POOTHURAIL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-3402
Mailing Address - Country:US
Mailing Address - Phone:847-208-1332
Mailing Address - Fax:
Practice Address - Street 1:612 E GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4510
Practice Address - Country:US
Practice Address - Phone:872-264-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.484908163WM0705X
IL209.028990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical