Healthcare Provider Details

I. General information

NPI: 1730002379
Provider Name (Legal Business Name): ANGELA JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 STRATFORD PL APT 22
BLOOMINGDALE IL
60108-2374
US

IV. Provider business mailing address

324 STRATFORD PL APT 22
BLOOMINGDALE IL
60108-2374
US

V. Phone/Fax

Practice location:
  • Phone: 630-600-8476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: