Healthcare Provider Details

I. General information

NPI: 1629464136
Provider Name (Legal Business Name): ANGELIA DOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S CHURCH ST APT 2A
BELLEVILLE IL
62220-2266
US

IV. Provider business mailing address

PO BOX 304
EAST SAINT LOUIS IL
62202-0304
US

V. Phone/Fax

Practice location:
  • Phone: 618-606-3734
  • Fax:
Mailing address:
  • Phone: 618-606-3734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number1504015
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1504015
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1504015
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1504015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: