MEDICARE: CHRISTY HARTLINE RN

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	163WC0400X	Case Management Registered Nurse	RN.1686806	CO

General Provider Information

NPI Number	:	1427831593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY HARTLINE RN

Provider Business Mailing Address
First Line	:	2751 WILDERNESS RD BLDG 9481
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4719
Country	:	US
Telephone Number	:	719-526-4064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 WILDERNESS RD BLDG 9481
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4719
Country	:	US
Telephone Number	:	719-526-4064
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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