Provider Demographics
NPI:1760133607
Name:HARTMAN, EMILY ROSE (MSN, PNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:DEMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1243 BAY RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1919
Mailing Address - Country:US
Mailing Address - Phone:607-425-0916
Mailing Address - Fax:
Practice Address - Street 1:1243 BAY RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1919
Practice Address - Country:US
Practice Address - Phone:607-425-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY716540163W00000X
NY383335363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse