Provider Demographics
NPI:1639805088
Name:HARTZELL, STEPHEN (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3242
Mailing Address - Country:US
Mailing Address - Phone:405-293-4160
Mailing Address - Fax:
Practice Address - Street 1:105 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3242
Practice Address - Country:US
Practice Address - Phone:405-293-4160
Practice Address - Fax:572-568-4501
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily