Provider Demographics
NPI:1750302014
Name:DANGELO, STEPHANIE (MSN, ANP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:DANGELO
Suffix:
Gender:F
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DANGELO
Other - Last Name:MIAZGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:9700 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4801
Mailing Address - Country:US
Mailing Address - Phone:630-252-1661
Mailing Address - Fax:630-252-6615
Practice Address - Street 1:9700 S CASS AVE
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4801
Practice Address - Country:US
Practice Address - Phone:630-252-1661
Practice Address - Fax:630-252-6615
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QX0100X
IL041303612363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine