=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548229768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA REGINA DETIE APN,CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2006
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 SEVEN HILLS DR STE 103
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-777-0414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 870 SEVEN HILLS DR STE 103
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-777-0414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | APN0512
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------