Provider Demographics
NPI:1982289765
Name:MIDDLETON, ANGELA MARIE (CNM, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7681 OLIVERS SHOP RD
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4149
Mailing Address - Country:US
Mailing Address - Phone:240-925-8120
Mailing Address - Fax:
Practice Address - Street 1:7681 OLIVERS SHOP RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4149
Practice Address - Country:US
Practice Address - Phone:240-925-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188693363LX0001X, 367A00000X
MDR239713367A00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant