Provider Demographics
NPI:1245459130
Name:HARTLE, JANNA (APRN)
Entity type:Individual
Prefix:MS
First Name:JANNA
Middle Name:
Last Name:HARTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 STONEMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
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:MURRAY
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201619-8900363LF0000X
UT201619-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP30598Medicare UPIN