Basic Information
| Provider Information | |||||||||
| NPI: | 1093261240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCANO | ||||||||
| FirstName: | ANGELIQUE | ||||||||
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| Credential: | ADN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 N TAFT AVE APT 1A | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601631558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736919625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 N MARINE DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041409996 | IL | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | U5664052901 | 01 | IL | CIGNA HEALTH AND LIFE INSURANCE CO. | OTHER |