MEDICARE: JAMES WILLIAM HARTLEY ARNP

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	0528	AK
2	363LF0000X	Family Nurse Practitioner	AP30006842	WA

General Provider Information

NPI Number	:	1972508836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM HARTLEY ARNP

Provider Business Mailing Address
First Line	:	240 THOMPSON RD
Second Line	:
City	:	SEDRO WOOLLEY
State	:	WA
Zip	:	98284-9515
Country	:	US
Telephone Number	:	360-303-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-6434
Fax Number	:	360-848-4233

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/21/2023

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