Provider Demographics
NPI:1922362110
Name:HARTZELL, WILL (MSOM)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FAIRWAY DR # 105
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5871
Mailing Address - Country:US
Mailing Address - Phone:406-587-2775
Mailing Address - Fax:
Practice Address - Street 1:2000 FAIRWAY DR # 105
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5871
Practice Address - Country:US
Practice Address - Phone:406-587-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist