Active NPI
Andrea Marie Roltgen, CPM, LM
- Midwife
- Hauser, ID
National Provider Identifier
1942087010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- MID-149
- Practice address
- 17632 N Advent LN
Hauser, ID 83854-5431 - Phone
- (208) 416-1701
- Fax
- (208) 216-1433
- NPI assigned
- Sep 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | MID-149 | ID | Primary |
Addresses
Primary practice location
17632 N Advent LN
Hauser, ID 83854-5431
Mailing address
17632 N Advent LN
Hauser, ID 83854-5431
Phone (208) 416-1701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MID-149 | ID | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1942087010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17632 N ADVENT LN",
"city": "HAUSER",
"state": "ID",
"postal_code": "838545431",
"telephone_number": "208-416-1701",
"fax_number": "208-216-1433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17632 N ADVENT LN",
"city": "HAUSER",
"state": "ID",
"postal_code": "838545431",
"telephone_number": "208-416-1701",
"fax_number": "208-216-1433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLTGEN",
"first_name": "ANDREA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "CPM, LM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-12",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "ID",
"license": "MID-149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hauser, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.