Healthcare Provider Details

I. General information

NPI: 1649554429
Provider Name (Legal Business Name): BETHANY EVANGELINE HANTZ LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY GATES CPM

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 EDGEWOOD RD NW STE 203A
CEDAR RAPIDS IA
52405-4472
US

IV. Provider business mailing address

222 EDGEWOOD RD NW STE 203A
CEDAR RAPIDS IA
52405-4472
US

V. Phone/Fax

Practice location:
  • Phone: 319-241-0147
  • Fax: 319-423-8071
Mailing address:
  • Phone: 319-241-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM0002
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCPM0002
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerIOWA LICENSED MIDWIFE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: