Provider Demographics
NPI:1801521869
Name:HARTUNG, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:HOVEN
Mailing Address - State:SD
Mailing Address - Zip Code:57450-0176
Mailing Address - Country:US
Mailing Address - Phone:605-252-8165
Mailing Address - Fax:
Practice Address - Street 1:1300 OAK ST
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-2149
Practice Address - Country:US
Practice Address - Phone:605-598-6262
Practice Address - Fax:605-598-4186
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily