Provider Demographics
NPI:1265249510
Name:HARTMAN, LEAH TAYLOR
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:TAYLOR
Last Name:HARTMAN
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 1:139 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4215
Mailing Address - Country:US
Mailing Address - Phone:518-210-9246
Mailing Address - Fax:
Practice Address - Street 1:4 OLD COUNTY ROAD EXT
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6241
Practice Address - Country:US
Practice Address - Phone:207-865-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELPN14511164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse