Provider Demographics
NPI:1336137405
Name:HARTMAN, MICHELLE S (CNM)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:S
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-602-9137
Mailing Address - Fax:303-602-9136
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:#225
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4514
Practice Address - Country:US
Practice Address - Phone:303-873-5245
Practice Address - Fax:303-873-5240
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129621367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23175800Medicaid
COC810273Medicare PIN