Provider Demographics
NPI:1356966121
Name:HARTMAN, JESSICA ELLEN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLEN
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 1:518 W DOW ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1208
Mailing Address - Country:US
Mailing Address - Phone:937-626-2805
Mailing Address - Fax:
Practice Address - Street 1:518 W DOW ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1208
Practice Address - Country:US
Practice Address - Phone:937-626-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider