Provider Demographics
NPI:1710340658
Name:WHITE, ANGEL (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 RING RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5459
Mailing Address - Country:US
Mailing Address - Phone:708-933-6346
Mailing Address - Fax:708-933-6356
Practice Address - Street 1:1477 RING RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5459
Practice Address - Country:US
Practice Address - Phone:708-933-6346
Practice Address - Fax:708-933-6346
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000582363LF0000X
IL209014142363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily