Provider Demographics
NPI:1093742892
Name:HARTMAN, MARY DIANE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DIANE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOCUST LANE
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9129
Mailing Address - Country:US
Mailing Address - Phone:717-766-3993
Mailing Address - Fax:
Practice Address - Street 1:503 N 21ST STREET
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2288
Practice Address - Country:US
Practice Address - Phone:717-763-2121
Practice Address - Fax:717-972-6944
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA28652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered