Provider Demographics
NPI:1285423830
Name:VEGA, ANGELA (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VEGA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7649
Mailing Address - Country:US
Mailing Address - Phone:847-857-0071
Mailing Address - Fax:
Practice Address - Street 1:2550 HAUSER ROSS DR STE 350
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3181
Practice Address - Country:US
Practice Address - Phone:815-758-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner