Provider Demographics
NPI:1073060265
Name:ANGDERSON, CHRISTIE MARIE (APN)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARIE
Last Name:ANGDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 W GOLF RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5611
Mailing Address - Country:US
Mailing Address - Phone:847-296-6706
Mailing Address - Fax:
Practice Address - Street 1:5540 TOUHY AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3234
Practice Address - Country:US
Practice Address - Phone:847-647-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily