Provider Demographics
NPI:1609031772
Name:HARTKE, MICHELE K (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:K
Last Name:HARTKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2255
Mailing Address - Country:US
Mailing Address - Phone:217-690-4393
Mailing Address - Fax:217-690-4392
Practice Address - Street 1:301 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2255
Practice Address - Country:US
Practice Address - Phone:217-690-4393
Practice Address - Fax:217-690-4392
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03042Medicare PIN