Provider Demographics
NPI:1265496368
Name:HARTSOCK, BETH (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HARTSOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6142
Mailing Address - Country:US
Mailing Address - Phone:207-778-4922
Mailing Address - Fax:207-779-0646
Practice Address - Street 1:131 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6142
Practice Address - Country:US
Practice Address - Phone:207-778-4922
Practice Address - Fax:207-779-0646
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER041286363L00000X
MECNP81586363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254880099Medicaid