Provider Demographics
NPI:1639418635
Name:HARTMAN, MICHELLE D (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-7510
Mailing Address - Country:US
Mailing Address - Phone:312-795-0006
Mailing Address - Fax:
Practice Address - Street 1:112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61559-7510
Practice Address - Country:US
Practice Address - Phone:312-795-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041333534163W00000X
IL209010351363L00000X
IL277001203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner