Healthcare Provider Details

I. General information

NPI: 1104022946
Provider Name (Legal Business Name): DIANNE L HARTWIG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8371 HIGHWAY 72 WEST SUITE 104
MADISON AL
35758-9505
US

IV. Provider business mailing address

PO BOX 2705
HUNSTVILLE AL
35804-2705
US

V. Phone/Fax

Practice location:
  • Phone: 256-726-6970
  • Fax: 256-726-6971
Mailing address:
  • Phone: 256-726-6970
  • Fax: 256-726-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-099703
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: