Provider Demographics
NPI:1932882073
Name:HARTMAN, RENEE (PHD, IMD, NMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PHD, IMD, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BRAMOOR DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-9500
Mailing Address - Country:US
Mailing Address - Phone:765-860-2144
Mailing Address - Fax:
Practice Address - Street 1:1520 BRAMOOR DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-9500
Practice Address - Country:US
Practice Address - Phone:765-860-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 171400000X, 175F00000X, 225200000X, 225400000X, 225700000X, 374K00000X, 261QH0700X, 261QM1300X
INLEHP1059202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty