Provider Demographics
NPI:1629573175
Name:HARTMAN, LISA (BSTM/HIM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:BSTM/HIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ELLEN STREET #62
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-9750
Mailing Address - Country:US
Mailing Address - Phone:219-242-4862
Mailing Address - Fax:
Practice Address - Street 1:607 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5727
Practice Address - Country:US
Practice Address - Phone:219-548-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information