Provider Demographics
NPI:1376714550
Name:HARTMANN, MARSHA HARRELL (PA-C)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:HARRELL
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:G
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2131 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7407
Mailing Address - Country:US
Mailing Address - Phone:910-667-7441
Mailing Address - Fax:910-667-5695
Practice Address - Street 1:2131 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-667-7441
Practice Address - Fax:910-667-5695
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103504363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical