Individual
ANGIE DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
6 WESTPORT CT, BLOOMINGTON, IL 61704-8233
(309) 722-4020
Mailing address
6 WESTPORT CT, BLOOMINGTON, IL 61704-8233
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
209.014746
IL
Other
Enumeration date
12/20/2016
Last updated
12/20/2016
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