MEDICARE: BARBARA VICTORIA HARTLEY FNP-C

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	363LF0000X	Family Nurse Practitioner	019534	OH
2	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CTP.020467.E	OTHER	OH	OHIO BOARD OF NURSING
2	RN.390716	OTHER	OH	OHIO BOARD OF NURSING
3	APRN.CNP.019534	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1952709297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA VICTORIA HARTLEY FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 73650
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0002
Country	:	US
Telephone Number	:	440-306-2358
Fax Number	:	440-306-2359

Provider Business Practice Location Address
First Line	:	2760 SOM CENTER RD
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9111
Country	:	US
Telephone Number	:	440-306-2358
Fax Number	:	440-306-2359

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

Provider Enumeration Date	:	12/19/2014
Last Update Date	:	01/20/2017

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