Provider Demographics
NPI:1013114511
Name:JEFFRIES, ANGELA MARIE (MSN CRNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5802
Mailing Address - Country:US
Mailing Address - Phone:630-420-4275
Mailing Address - Fax:630-420-8957
Practice Address - Street 1:4043 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5802
Practice Address - Country:US
Practice Address - Phone:630-420-4275
Practice Address - Fax:630-420-8957
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007209363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics