Provider Demographics
NPI:1669598710
Name:HARTLE, CATHY A (FNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:HARTLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W BATES ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63384-1616
Mailing Address - Country:US
Mailing Address - Phone:573-684-2208
Mailing Address - Fax:573-684-3277
Practice Address - Street 1:111 W BATES ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63384-1616
Practice Address - Country:US
Practice Address - Phone:573-684-2208
Practice Address - Fax:573-684-3277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO147449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily