Healthcare Provider Details

I. General information

NPI: 1548149933
Provider Name (Legal Business Name): LIVING WELL INTEGRATIVE CHRISTIAN WOMENS HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 EAST COLLEGE AVENUE STE C
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

2501 E COLLEGE AVE STE C
BLOOMINGTON IL
61704-2484
US

V. Phone/Fax

Practice location:
  • Phone: 815-246-2208
  • Fax: 309-326-4550
Mailing address:
  • Phone: 815-246-2208
  • Fax: 309-326-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA T KLEIN
Title or Position: SOLE MEMBER
Credential: WHNP-BC
Phone: 815-246-2208