Provider Demographics
NPI:1235807900
Name:STANLEY, ANGELA M (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:607 S SHABBONA RD
Mailing Address - Street 2:
Mailing Address - City:SHABBONA
Mailing Address - State:IL
Mailing Address - Zip Code:60550-9785
Mailing Address - Country:US
Mailing Address - Phone:815-739-7309
Mailing Address - Fax:
Practice Address - Street 1:612 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5089
Practice Address - Country:US
Practice Address - Phone:815-227-8331
Practice Address - Fax:855-243-0207
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine