Provider Demographics
NPI:1467798371
Name:HARTKE, DEBBIE RAY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:RAY
Last Name:HARTKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 CHERRY HILLS CT.
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-795-5702
Mailing Address - Fax:805-499-5702
Practice Address - Street 1:293 CHERRY HILLS CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-4171
Practice Address - Country:US
Practice Address - Phone:805-795-5702
Practice Address - Fax:805-499-5702
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor