Provider Demographics
NPI:1649534777
Name:HARTMAN, LYDIA ARISSA (CNM)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:ARISSA
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 GULL PRAIRIE WAY
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3010
Mailing Address - Country:US
Mailing Address - Phone:269-254-5085
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE N1200
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5318
Practice Address - Country:US
Practice Address - Phone:269-341-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704203535367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife