Individual provider · Type 1 NPI

Dietra Leigh Angelly, FNP-C

Nurse Practitioner · Marion, IL

NPI number 1902371313 Active

Practice location

3411 Professional Park Dr
Marion, IL 62959-6394

Call (618) 969-8630 Map

Fax (618) 993-1421

Mailing address

408 Lincoln Dr Ste B
Herrin, IL 62948-3790

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner 363LF0000X209018044 (IL)
Nurse Practitioner Primary 363L00000X209018044 (IL)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1902371313

Dietra Leigh Angelly, FNP-C's National Provider Identifier is 1902371313, issued on Oct 11, 2018. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Marion, IL. The record was last updated on Apr 8, 2024.