Provider Demographics
NPI:1194062091
Name:NADINE HARTWIG, NP-C, LLC
Entity type:Organization
Organization Name:NADINE HARTWIG, NP-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:256-604-0294
Mailing Address - Street 1:4001 DEVON ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1017
Mailing Address - Country:US
Mailing Address - Phone:256-604-0294
Mailing Address - Fax:877-999-0294
Practice Address - Street 1:4001 DEVON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1017
Practice Address - Country:US
Practice Address - Phone:256-604-0294
Practice Address - Fax:877-999-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-040411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G505171Medicare PIN