Provider Demographics
NPI:1841398468
Name:YOCOM, ANGIE D (APN BC FNP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:D
Last Name:YOCOM
Suffix:
Gender:F
Credentials:APN BC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2258
Mailing Address - Country:US
Mailing Address - Phone:217-342-9738
Mailing Address - Fax:217-342-9806
Practice Address - Street 1:414 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2258
Practice Address - Country:US
Practice Address - Phone:217-342-9738
Practice Address - Fax:217-342-9806
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005974363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner