Provider Demographics
NPI:1780007567
Name:MCGOUGH, ANGELICA J (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:J
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:25 N WINFIELD RD STE 2202
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-933-4847
Mailing Address - Fax:630-933-3826
Practice Address - Street 1:25 N WINFIELD RD STE 2202
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-933-4847
Practice Address - Fax:630-933-3826
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011217363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400134207OtherMEDICARE PTAN (INDIVIDUAL)
IL206147OtherMEDICARE PTAN (GROUP)
IL206147OtherMEDICARE PTAN (GROUP)