Healthcare Provider Details

I. General information

NPI: 1982289765
Provider Name (Legal Business Name): ANGELA MARIE MIDDLETON CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2021
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7681 OLIVERS SHOP RD
LA PLATA MD
20646-4149
US

IV. Provider business mailing address

7681 OLIVERS SHOP RD
LA PLATA MD
20646-4149
US

V. Phone/Fax

Practice location:
  • Phone: 240-925-8120
  • Fax:
Mailing address:
  • Phone: 240-925-8120
  • Fax: 877-552-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024188693
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024188693
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR239713
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR239713
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: