Healthcare Provider Details

I. General information

NPI: 1801841945
Provider Name (Legal Business Name): JENNIFER LEE HARTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEE CADE PA-C

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 S STATE ROAD 135 STE F
GREENWOOD IN
46142-1407
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000688A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: