Provider Demographics
NPI:1255773735
Name:HARTLIEB, SUMMER ASHLEY (LPN)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ASHLEY
Last Name:HARTLIEB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1815
Mailing Address - Country:US
Mailing Address - Phone:717-507-1294
Mailing Address - Fax:
Practice Address - Street 1:209 S LANCASTER ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1815
Practice Address - Country:US
Practice Address - Phone:717-507-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276820164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse