Provider Demographics
NPI:1083367148
Name:HOTZ, ANGELA (LM, CPM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HOTZ
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-0098
Mailing Address - Country:US
Mailing Address - Phone:360-808-3973
Mailing Address - Fax:360-826-8256
Practice Address - Street 1:916 S 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4324
Practice Address - Country:US
Practice Address - Phone:360-808-3973
Practice Address - Fax:360-826-8250
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2024-11-10
Deactivation Date:2022-01-29
Deactivation Code:
Reactivation Date:2022-03-08
Provider Licenses
StateLicense IDTaxonomies
WAMW61232444176B00000X
WAMW6123244176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty