Provider Demographics
NPI:1407359730
Name:HARTLEY, ELIZABETH BROOKE (LAC, MOM, NTP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROOKE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LAC, MOM, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20015 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MD
Mailing Address - Zip Code:21053-9433
Mailing Address - Country:US
Mailing Address - Phone:207-664-3152
Mailing Address - Fax:
Practice Address - Street 1:20015 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MD
Practice Address - Zip Code:21053-9433
Practice Address - Country:US
Practice Address - Phone:207-664-3152
Practice Address - Fax:207-664-3152
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty