Provider Demographics
NPI:1972793016
Name:REIDNER, ANGELA (RN, MS, CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:REIDNER
Suffix:
Gender:F
Credentials:RN, MS, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16460 2400 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-8743
Mailing Address - Country:US
Mailing Address - Phone:815-221-4023
Mailing Address - Fax:
Practice Address - Street 1:334 BACKBONE RD E
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-9685
Practice Address - Country:US
Practice Address - Phone:815-221-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309-000460367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP60538Medicare UPIN
IL819300033Medicare PIN