Provider Demographics
NPI:1700042959
Name:KLEIN, ANGELA THERESE (APN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:THERESE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7910
Mailing Address - Country:US
Mailing Address - Phone:309-454-3456
Mailing Address - Fax:309-454-6977
Practice Address - Street 1:1505 EASTLAND DR STE 2200
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7910
Practice Address - Country:US
Practice Address - Phone:309-454-3456
Practice Address - Fax:309-454-6977
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007175363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health