Healthcare Provider Details

I. General information

NPI: 1225091986
Provider Name (Legal Business Name): ANGEL D ATKINS CNM, WHNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 N KNOXVILLE AVE
PEORIA IL
61604-2869
US

IV. Provider business mailing address

26962 DON ST
HOPEDALE IL
61747-9624
US

V. Phone/Fax

Practice location:
  • Phone: 309-370-1025
  • Fax: 309-266-5340
Mailing address:
  • Phone: 309-370-1025
  • Fax: 309-266-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number277-001559
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209005714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: