Provider Demographics
NPI:1275596272
Name:HARTMAN, STEPHANIE (CNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BOETTLER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7792
Mailing Address - Country:US
Mailing Address - Phone:330-899-5730
Mailing Address - Fax:330-899-0522
Practice Address - Street 1:1700 BOETTLER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7792
Practice Address - Country:US
Practice Address - Phone:330-899-5730
Practice Address - Fax:330-899-0522
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP07450363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2456471Medicaid
OH2456471Medicaid