Healthcare Provider Details

I. General information

NPI: 1083367148
Provider Name (Legal Business Name): ANGELA HOTZ LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date: 01/29/2022
Reactivation Date: 03/08/2022

III. Provider practice location address

916 S 3RD ST STE B
MOUNT VERNON WA
98273-4324
US

IV. Provider business mailing address

PO BOX 98
MOUNT VERNON WA
98273-0098
US

V. Phone/Fax

Practice location:
  • Phone: 360-808-3973
  • Fax: 360-826-8250
Mailing address:
  • Phone: 360-808-3973
  • Fax: 360-826-8256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW61232444
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW6123244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: