Provider Demographics
NPI:1265155279
Name:HARTLEY, MANDY BETH
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:BETH
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PRICKETTS FORT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-5159
Mailing Address - Country:US
Mailing Address - Phone:304-612-1101
Mailing Address - Fax:
Practice Address - Street 1:37 PRICKETTS FORT RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-5159
Practice Address - Country:US
Practice Address - Phone:304-612-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant