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General NPI Number Information
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NPI Number | 1548149933
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Entity Type | Organization
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Legal Business Name | LIVING WELL INTEGRATIVE CHRISTIAN WOMENS HEALTHCARE PLLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2501 EAST COLLEGE AVENUE STE C
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City | BLOOMINGTON
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State | IL
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Zip | 61704
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Country | US
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Telephone | 815-246-2208
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Fax | 309-326-4550
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Provider Business Mailing Address
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Address Line | 2501 E COLLEGE AVE STE C
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2484
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Country | US
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Telephone | 815-246-2208
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Fax | 309-326-4550
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ANGELA T KLEIN
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Credential | WHNP-BC
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Telephone | 815-246-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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