Healthcare Provider Details

I. General information

NPI: 1659379279
Provider Name (Legal Business Name): JANE A HARTNETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W MAIN ST
MANCHESTER IA
52057-1527
US

IV. Provider business mailing address

709 W MAIN ST
MANCHESTER IA
52057-1526
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-2629
  • Fax: 563-927-5247
Mailing address:
  • Phone: 563-927-2629
  • Fax: 563-927-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28440
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: