Provider Demographics
NPI:1992006613
Name:HILL, ANGELA (CD, CPPD, SBD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:CD, CPPD, SBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 KATHY DR
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3632
Mailing Address - Country:US
Mailing Address - Phone:618-541-6359
Mailing Address - Fax:
Practice Address - Street 1:113 KATHY DR
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-3632
Practice Address - Country:US
Practice Address - Phone:618-541-6359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7861-C-48174400000X, 374J00000X
OK2015-TTH-000173176B00000X
CA7861-53374J00000X
MOSBD20110428374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2015-TTH-000173Other5 FC INDIGENOUS HEALTHCARE PRACTITIONERS ORGANIZATION
CA7861-C-48OtherMADRIELLA DOULA CERTIFICATION