Provider Demographics
NPI:1093261240
Name:ESCANO, ANGELIQUE (ADN)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:ESCANO
Suffix:
Gender:F
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N TAFT AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1558
Mailing Address - Country:US
Mailing Address - Phone:773-691-9625
Mailing Address - Fax:
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-878-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041409996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU5664052901OtherCIGNA HEALTH AND LIFE INSURANCE CO.