Provider Demographics
NPI:1619416419
Name:HARTMAN, MICHELLE DENISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DENISE
Other - Last Name:PENIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1727 BONNYCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1014
Mailing Address - Country:US
Mailing Address - Phone:410-703-4581
Mailing Address - Fax:
Practice Address - Street 1:1727 BONNYCASTLE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1014
Practice Address - Country:US
Practice Address - Phone:410-703-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily