Healthcare Provider Details

I. General information

NPI: 1235764424
Provider Name (Legal Business Name): AMBER DAWN HARTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 COLLINS RD NE
CEDAR RAPIDS IA
52402-3201
US

IV. Provider business mailing address

153 COLLINS RD NE
CEDAR RAPIDS IA
52402-3201
US

V. Phone/Fax

Practice location:
  • Phone: 319-826-2972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA157309
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA157309
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: