Provider Demographics
NPI:1568759520
Name:HARTMAN, SARAH LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5903
Mailing Address - Country:US
Mailing Address - Phone:309-249-0069
Mailing Address - Fax:309-524-4654
Practice Address - Street 1:3061 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5903
Practice Address - Country:US
Practice Address - Phone:309-249-0069
Practice Address - Fax:309-524-4654
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid
IA1598759292Medicaid