Provider Demographics
NPI:1649640814
Name:HARTUNG, ALEAH KRISTIN (DMSC, PA-C)
Entity type:Individual
Prefix:
First Name:ALEAH
Middle Name:KRISTIN
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:DMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 CAUGHLIN XING
Mailing Address - Street 2:#100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0611
Mailing Address - Country:US
Mailing Address - Phone:775-348-9798
Mailing Address - Fax:775-348-5809
Practice Address - Street 1:7025 LONGLEY LN STE 60
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1239
Practice Address - Country:US
Practice Address - Phone:775-453-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52441363A00000X
NVPA1641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1649640814Medicaid