Provider Demographics
NPI:1124397559
Name:HARTKE, MICHELLE LEANN (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEANN
Last Name:HARTKE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 N PICKETWIRE LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6571
Mailing Address - Country:US
Mailing Address - Phone:719-242-7757
Mailing Address - Fax:
Practice Address - Street 1:1619 N GREENWOOD ST STE 208
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2656
Practice Address - Country:US
Practice Address - Phone:719-543-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP990297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily