Provider Demographics
NPI:1992059018
Name:HARTLEY, JEAN ANN (LM, CPM)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25998 142ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-8762
Mailing Address - Country:US
Mailing Address - Phone:254-295-7657
Mailing Address - Fax:
Practice Address - Street 1:25998 142ND ST NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-8762
Practice Address - Country:US
Practice Address - Phone:254-295-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN