Tacderas, Angelito Dariel

Tacderas, Angelito Dariel is an sole proprietor health care provider with primary practice located at 3331 W Deyoung St Ste 308, Marion IL 62959-5896. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Tacderas, Angelito Dariel can be contacted via phone (618) 997-1200.

Contact Information

Primary practice address
3331 W Deyoung St Ste 308 Marion IL 62959-5896
Phone: (618) 997-1200
Fax: (618) 997-1212
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209.007762 Illinois

Profile Details

NPI number 1467785014
LBN Legal business name Tacderas, Angelito Dariel
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 15th, 2009
Last updated Sep 15th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467785014 NPPES
Illinois MEDICAID PENDING

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