Provider Demographics
NPI:1265783070
Name:KRELO, ANGELA (SURGICAL/MEDICAL AS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KRELO
Suffix:
Gender:F
Credentials:SURGICAL/MEDICAL AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUSHING DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948
Mailing Address - Country:US
Mailing Address - Phone:618-998-8808
Mailing Address - Fax:618-998-8809
Practice Address - Street 1:305 W. JACKSON SUITE 402
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-529-4711
Practice Address - Fax:618-998-8809
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist