MEDICARE: MRS. ANGELA THERESE KLEIN APN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	209007175	IL

General Provider Information

NPI Number	:	1700042959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA THERESE KLEIN APN

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	:	309-336-4743
Fax Number	:	309-425-8529

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	03/12/2026

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