Provider Demographics
NPI:1639882434
Name:HARTONG, ALISON MARIE
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARIE
Last Name:HARTONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:BACHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1360 DEAGLEWAY DR APT H
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9475
Mailing Address - Country:US
Mailing Address - Phone:937-717-8302
Mailing Address - Fax:
Practice Address - Street 1:2929 FOREST LAWN DR APT 4
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-8853
Practice Address - Country:US
Practice Address - Phone:937-717-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000306866OtherSTATE OF OHIO SUPPLIER REGISTRATION NUMBER