Provider Demographics
NPI:1043239932
Name:HARTFORD, KAREY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREY
Middle Name:
Last Name:HARTFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49310 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1335
Mailing Address - Country:US
Mailing Address - Phone:586-731-8900
Mailing Address - Fax:586-726-5439
Practice Address - Street 1:49310 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-1335
Practice Address - Country:US
Practice Address - Phone:586-731-8900
Practice Address - Fax:586-726-5439
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4782497Medicaid
Q53459Medicare UPIN
MI4782497Medicaid