Provider Demographics
NPI:1942478540
Name:JANNA HARTLE LLC
Entity Type:Organization
Organization Name:JANNA HARTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-274-1447
Mailing Address - Street 1:1553 STONEMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2515
Mailing Address - Country:US
Mailing Address - Phone:801-274-1447
Mailing Address - Fax:801-273-0775
Practice Address - Street 1:1553 STONEMOOR CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2515
Practice Address - Country:US
Practice Address - Phone:801-274-1447
Practice Address - Fax:801-273-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201619-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP30598Medicare UPIN