MEDICARE: GERALD A HARTLE JR. CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP0005684B	PA

General Provider Information

NPI Number	:	1194722751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD A HARTLE JR. CRNP

Provider Business Mailing Address
First Line	:	20440 ROUTE 19
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066
Country	:	US
Telephone Number	:	724-779-2273
Fax Number	:	724-779-3006

Provider Business Practice Location Address
First Line	:	20440 ROUTE 19
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-0000
Country	:	US
Telephone Number	:	724-779-2273
Fax Number	:	724-779-3006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/13/2007

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