Provider Demographics
NPI:1730683483
Name:HARTLEY, ANGELA (CPM, LDM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:CPM, LDM
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 211
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:OR
Mailing Address - Zip Code:97544-0211
Mailing Address - Country:US
Mailing Address - Phone:831-566-0877
Mailing Address - Fax:
Practice Address - Street 1:3600 CEDAR FLAT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:OR
Practice Address - Zip Code:97544-9682
Practice Address - Country:US
Practice Address - Phone:541-846-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10189771176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife