Provider Demographics
NPI:1215160825
Name:HARTMAN, DENISE RAE (LPN)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:RAE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ROSLYN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1634
Mailing Address - Country:US
Mailing Address - Phone:330-452-1450
Mailing Address - Fax:
Practice Address - Street 1:724 ROSLYN AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1634
Practice Address - Country:US
Practice Address - Phone:330-452-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 088991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse