Provider Demographics
NPI:1992238810
Name:MCCORMICK, ANGELA FAITH (NP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAITH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:FAITH
Other - Last Name:NATION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:125 E PLUMMER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8136
Mailing Address - Country:US
Mailing Address - Phone:174-833-3332
Mailing Address - Fax:217-483-4393
Practice Address - Street 1:125 E PLUMMER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8136
Practice Address - Country:US
Practice Address - Phone:174-833-3332
Practice Address - Fax:217-483-4393
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041362669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner