Provider Demographics
NPI:1265093249
Name:HARTFIELD, MICHAEL GRAGORY (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRAGORY
Last Name:HARTFIELD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BEDFORD RD APT 1211
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7168
Mailing Address - Country:US
Mailing Address - Phone:972-207-5632
Mailing Address - Fax:
Practice Address - Street 1:1520 BEDFORD RD APT 1211
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7168
Practice Address - Country:US
Practice Address - Phone:972-207-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse