Provider Demographics
NPI:1124355110
Name:HARTWELL, BROOKE HATTEN (RN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:HATTEN
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 N HIGHLAND AVE NE
Mailing Address - Street 2:APT. 9
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4557
Mailing Address - Country:US
Mailing Address - Phone:773-316-1514
Mailing Address - Fax:
Practice Address - Street 1:641 N HIGHLAND AVE NE
Practice Address - Street 2:APT. 9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4557
Practice Address - Country:US
Practice Address - Phone:404-727-3769
Practice Address - Fax:404-727-8249
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse