Provider Demographics
NPI:1689813883
Name:NAEGELE, ROBERTA A (APN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:A
Last Name:NAEGELE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 W GRAND AVE
Mailing Address - Street 2:#101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1571
Mailing Address - Country:US
Mailing Address - Phone:312-773-9858
Mailing Address - Fax:
Practice Address - Street 1:2158 W GRAND AVE
Practice Address - Street 2:#101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1571
Practice Address - Country:US
Practice Address - Phone:312-773-9858
Practice Address - Fax:815-774-9234
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily