Provider Demographics
NPI:1184035990
Name:HARTENFELD, MAHOGANY M (LPN)
Entity Type:Individual
Prefix:
First Name:MAHOGANY
Middle Name:M
Last Name:HARTENFELD
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 1:3217 GLANZMAN RD
Mailing Address - Street 2:D39
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3864
Mailing Address - Country:US
Mailing Address - Phone:419-205-8706
Mailing Address - Fax:
Practice Address - Street 1:3217 GLANZMAN RD
Practice Address - Street 2:D39
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3864
Practice Address - Country:US
Practice Address - Phone:419-205-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse