Provider Demographics
NPI:1689928681
Name:HARTKER, MAUREEN MCMAHON (LAC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCMAHON
Last Name:HARTKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2029
Mailing Address - Country:US
Mailing Address - Phone:415-521-8133
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2810
Practice Address - Country:US
Practice Address - Phone:415-521-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist