Provider Demographics
NPI:1225030026
Name:HARTLEY, MARGARET MARY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARY
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:35 LINDBERGH DR UNIT 110
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-5461
Mailing Address - Country:US
Mailing Address - Phone:907-431-2871
Mailing Address - Fax:883-331-1384
Practice Address - Street 1:35 LINDBERGH DR UNIT 110
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-5461
Practice Address - Country:US
Practice Address - Phone:970-431-2871
Practice Address - Fax:883-331-1384
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO506363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07005069Medicaid
224658Medicare ID - Type Unspecified
CO07005069Medicaid
CO304308Medicare PIN