Provider Demographics
NPI:1477377646
Name:ENGRACIA, MARIA ANGELA THEA
Entity type:Individual
Prefix:
First Name:MARIA ANGELA
Middle Name:THEA
Last Name:ENGRACIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8012
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-8012
Mailing Address - Country:US
Mailing Address - Phone:224-269-4549
Mailing Address - Fax:
Practice Address - Street 1:1701 E WOODFIELD RD STE 401
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5126
Practice Address - Country:US
Practice Address - Phone:224-269-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041387134163WP0809X
IL209031173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult