Provider Demographics
NPI:1144663345
Name:HARTSOCK, JANE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:HARTSOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2747
Mailing Address - Country:US
Mailing Address - Phone:307-577-7737
Mailing Address - Fax:307-577-0049
Practice Address - Street 1:1900 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2747
Practice Address - Country:US
Practice Address - Phone:307-577-7737
Practice Address - Fax:307-577-0049
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY25858-1082163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1144663345Medicaid
WYW25494Medicare PIN