1639882434 NPI number — MRS. ALISON MARIE HARTONG

Table of content: MRS. ALISON MARIE HARTONG (NPI 1639882434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639882434 NPI number — MRS. ALISON MARIE HARTONG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTONG
Provider First Name:
ALISON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BACHOWSKI
Provider Other First Name:
ALISON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639882434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 DEAGLEWAY DR APT H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBORN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45324-9475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-717-8302
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2929 FOREST LAWN DR APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45431-8853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-717-8302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000306866 . This is a "STATE OF OHIO SUPPLIER REGISTRATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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