Provider Demographics
NPI:1568203099
Name:HARTMAN, ELIZABETH NOELLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOELLE
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 1:113 WALTER STREET
Mailing Address - Street 2:
Mailing Address - City:CRIDERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45806-2270
Mailing Address - Country:US
Mailing Address - Phone:419-860-8192
Mailing Address - Fax:
Practice Address - Street 1:113 WALTER ST
Practice Address - Street 2:
Practice Address - City:CRIDERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45806-2270
Practice Address - Country:US
Practice Address - Phone:419-860-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant