Provider Demographics
NPI:1275848244
Name:SANTANGELO, STACIE R (RN, MS, APN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:R
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:RN, MS, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S450 SUMMIT AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3952
Mailing Address - Country:US
Mailing Address - Phone:630-320-6871
Mailing Address - Fax:630-385-0026
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Practice Address - Street 2:NORTHWESTERN MEDICAL GROUP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5969
Practice Address - Country:US
Practice Address - Phone:312-695-4965
Practice Address - Fax:312-695-0005
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005000364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine