Individual
ANGELA ROSE DEPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018117
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018012582
CERTIFICATION
IL
05
—
209018117
—
IL
Enumeration date
10/16/2018
Last updated
12/20/2021
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