Provider Demographics
NPI:1356081392
Name:AVENT, ANGELA JOY (LM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:AVENT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JOY
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2380 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1448
Mailing Address - Country:US
Mailing Address - Phone:505-352-4830
Mailing Address - Fax:
Practice Address - Street 1:2380 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1448
Practice Address - Country:US
Practice Address - Phone:505-352-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM22002R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife