MEDICARE: LIVING WELL INTEGRATIVE CHRISTIAN WOMENS HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner
3	363LW0102X	Women's Health Nurse Practitioner

General Provider Information

NPI Number	:	1548149933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL INTEGRATIVE CHRISTIAN WOMENS HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	2501 E COLLEGE AVE STE C
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-2484
Country	:	US
Telephone Number	:	815-246-2208
Fax Number	:	309-326-4550

Provider Business Practice Location Address
First Line	:	2501 E COLLEGE AVE STE C
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-2484
Country	:	US
Telephone Number	:	309-336-4743
Fax Number	:	309-425-8529

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ANGELA T KLEIN
Credential	:	WHNP-BC
Telephone Number	:	815-246-2208

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	03/12/2026

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