Provider Demographics
NPI:1811319684
Name:HARTMAN, ELIZABETH (CPM LM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12913 THREE POINT ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5303
Mailing Address - Country:US
Mailing Address - Phone:208-249-8819
Mailing Address - Fax:
Practice Address - Street 1:12913 THREE POINT ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5303
Practice Address - Country:US
Practice Address - Phone:208-249-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-52176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife