Provider Demographics
NPI:1326523432
Name:DELAWDER, ANGELA D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:DELAWDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5369
Mailing Address - Country:US
Mailing Address - Phone:630-244-7980
Mailing Address - Fax:
Practice Address - Street 1:5015 W 65TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-5701
Practice Address - Country:US
Practice Address - Phone:708-924-8000
Practice Address - Fax:708-924-8008
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant