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Contact Information

DIETRA L ANGELLY, FNP-C
3411 PROFESSIONAL PARK DR
MARION, IL62959-6394
 Phone: 618-969-8630
 Fax: 618-993-1421
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for DIETRA L ANGELLY · (Female)

NPI # 1902371313
Status Active
Credentials FNP-C (Family Nurse Practitioner, Certified)
Entity Individual
Enumeration date 10/11/2018
Last updated 04/08/2024 - About 2 years ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 209018044
Hospital affiliation(s)
  • HERRIN HOSPITAL - (Acute Care)
    201 S 14TH ST
    HERRIN, IL 62948
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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