Provider Demographics
NPI:1821463522
Name:BRUNFELDT, ANGELA (APN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRUNFELDT
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 1:1717 WEST CONGRESS PKWY
Mailing Address - Street 2:SUITE 10 KELLOGG
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:785-766-3410
Mailing Address - Fax:
Practice Address - Street 1:1717 WEST CONGRESS PKWY
Practice Address - Street 2:SUITE 10 KELLOGG
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:785-766-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012977363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care