Provider Demographics
NPI:1073009593
Name:HARTEIS, ARICA (LPN)
Entity Type:Individual
Prefix:
First Name:ARICA
Middle Name:
Last Name:HARTEIS
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 1:105 W CAYUGA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1447
Mailing Address - Country:US
Mailing Address - Phone:315-746-0614
Mailing Address - Fax:
Practice Address - Street 1:105 W CAYUGA ST APT 1
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1447
Practice Address - Country:US
Practice Address - Phone:315-746-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326292-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty