1871604702 NPI number — MRS. ELIZABETH H HARTMAN ANP

Table of content: MRS. ELIZABETH H HARTMAN ANP (NPI 1871604702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871604702 NPI number — MRS. ELIZABETH H HARTMAN ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTMAN
Provider First Name:
ELIZABETH
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1871604702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 MEDICAL VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05855-9835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-334-3504
Provider Business Mailing Address Fax Number:
802-334-3512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855-9835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-334-3504
Provider Business Practice Location Address Fax Number:
802-334-3512
Provider Enumeration Date:
08/31/2006

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: 363LF0000X , with the licence number:  1010009657 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500004079 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 8000222 . This is a "LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 356627 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00028667 . This is a "BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0NP0618 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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