Provider Demographics
NPI:1225091986
Name:ATKINS, ANGEL D (CNM, WHNP, APN)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:D
Last Name:ATKINS
Suffix:
Gender:F
Credentials:CNM, WHNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26962 DON ST
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-9624
Mailing Address - Country:US
Mailing Address - Phone:309-370-1025
Mailing Address - Fax:309-266-5340
Practice Address - Street 1:2805 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-2869
Practice Address - Country:US
Practice Address - Phone:309-370-1025
Practice Address - Fax:309-266-5340
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005714367A00000X
IL277-001559363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23262Medicare ID - Type Unspecified
3R9613Medicare UPIN