Provider Demographics
NPI:1659847309
Name:CHAU, ANGELINE
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 SPRING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3944
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:
Practice Address - Street 1:6404 MERIWETHER LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1302
Practice Address - Country:US
Practice Address - Phone:703-999-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty