Individual
MR. ANGELITO DARIEL TACDERAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
3331 W DEYOUNG ST, STE 308, MARION, IL 62959-5896
(618) 997-1200
(618) 997-1212
Mailing address
PO BOX 430, MARION, IL 62959-0430
(618) 997-1200
(618) 997-1212
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.007762
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
09/15/2009
Last updated
09/15/2009
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