Healthcare Provider Details

I. General information

NPI: 1184814923
Provider Name (Legal Business Name): MARY ALEXANDRA HARTMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LAFAYETTE ST
NEW BRITAIN CT
06051-1803
US

IV. Provider business mailing address

22 SOUTH GREEN STREET
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13819
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR164047
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR164047
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: