Provider Demographics
NPI:1750928123
Name:HART, JOSHUA (LPN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9071
Mailing Address - Country:US
Mailing Address - Phone:248-210-5619
Mailing Address - Fax:
Practice Address - Street 1:5351 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9071
Practice Address - Country:US
Practice Address - Phone:248-210-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703122483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse