Provider Demographics
NPI:1700283744
Name:ANGIE LANDIS
Entity Type:Organization
Organization Name:ANGIE LANDIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-818-9947
Mailing Address - Street 1:2517 SHIELDS RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-7104
Mailing Address - Country:US
Mailing Address - Phone:240-818-9947
Mailing Address - Fax:
Practice Address - Street 1:2517 SHIELDS RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-7104
Practice Address - Country:US
Practice Address - Phone:240-818-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty