Provider Demographics
NPI:1609026061
Name:NIEUKIRK, ANGELA FAITH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAITH
Last Name:NIEUKIRK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2205
Mailing Address - Country:US
Mailing Address - Phone:309-694-0805
Mailing Address - Fax:
Practice Address - Street 1:1201 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-1243
Practice Address - Country:US
Practice Address - Phone:309-444-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0570011828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist