Provider Demographics
NPI:1639117112
Name:HARTMAN, ELLEN E (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:E
Other - Last Name:YEAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:5257 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2228
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021973OtherKAISER COMMERCIAL NUMBER
CO36205028Medicaid
P00002637OtherMEDICARE RAILROAD
CO021973OtherKAISER COMMERCIAL NUMBER
CO36205028Medicaid
COCOA106171Medicare PIN