Provider Demographics
NPI:1881360550
Name:BOISEN, ANGELA (CPM, LM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BOISEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639
Mailing Address - Country:US
Mailing Address - Phone:608-293-1081
Mailing Address - Fax:608-480-8101
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639-0000
Practice Address - Country:US
Practice Address - Phone:608-293-1081
Practice Address - Fax:608-480-8101
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
WI276-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay