Provider Demographics
NPI:1891141099
Name:HARTMAN, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68086 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9514
Mailing Address - Country:US
Mailing Address - Phone:269-414-8199
Mailing Address - Fax:
Practice Address - Street 1:68086 CHERRY LN
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9514
Practice Address - Country:US
Practice Address - Phone:269-414-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other