Provider Demographics
NPI:1104022946
Name:HARTWIG, DIANNE L (CRNP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:L
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNSTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-726-6970
Mailing Address - Fax:256-726-6971
Practice Address - Street 1:8371 HIGHWAY 72 WEST
Practice Address - Street 2:SUITE 104
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9505
Practice Address - Country:US
Practice Address - Phone:256-726-6970
Practice Address - Fax:256-726-6971
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-099703OtherLICENSE NUMBER