Healthcare Provider Details

I. General information

NPI: 1427450477
Provider Name (Legal Business Name): STEPHANIE LYNN HARTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

IV. Provider business mailing address

2662 EDITH AVENUE
REDDING CA
96001
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax: 559-440-1318
Mailing address:
  • Phone: 530-242-1266
  • Fax: 530-243-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: