Provider Demographics
NPI:1407291933
Name:PUCHA, ANGELICA MARIA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:MARIA
Last Name:PUCHA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W HAWTHORN PKWY STE 370
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1449
Mailing Address - Country:US
Mailing Address - Phone:847-918-8282
Mailing Address - Fax:
Practice Address - Street 1:3 W HAWTHORN PKWY STE 370
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1449
Practice Address - Country:US
Practice Address - Phone:847-918-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health