Provider Demographics
NPI:1649554429
Name:HANTZ, BETHANY EVANGELINE (LM, CPM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:EVANGELINE
Last Name:HANTZ
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM
Mailing Address - Street 1:361 ESSEX DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1418
Mailing Address - Country:US
Mailing Address - Phone:319-241-0147
Mailing Address - Fax:
Practice Address - Street 1:1450 BOYSON RD STE C4
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2340
Practice Address - Country:US
Practice Address - Phone:319-241-0147
Practice Address - Fax:319-423-8071
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACPM0002176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACPM0002OtherIOWA LICENSED MIDWIFE