Provider Demographics
NPI:1336565134
Name:TODD, ANGELA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:TODD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1306 GEMINI CIR STE 1
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350
Practice Address - Country:US
Practice Address - Phone:815-433-9200
Practice Address - Fax:815-705-1716
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2021-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209.010887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.010887OtherIL LICENSE