Provider Demographics
NPI:1003271586
Name:PETERSON, ANGELA OBONDO (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:OBONDO
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ATIENO
Other - Last Name:OBONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST FL 17
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-0516
Practice Address - Street 1:259 E ERIE ST FL 17
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-0516
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028749363LF0000X
390200000X
IL209025487363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program