Provider Demographics
NPI:1215530449
Name:HARTMAN, BREANNA ALANE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:ALANE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0485
Mailing Address - Country:US
Mailing Address - Phone:304-668-5458
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1796
Practice Address - Country:US
Practice Address - Phone:304-257-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant