Healthcare Provider Details

I. General information

NPI: 1598444572
Provider Name (Legal Business Name): VIRGINIA MARIE HARTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

9911 E 21ST ST N APT 323
WICHITA KS
67206-3524
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax:
Mailing address:
  • Phone: 316-253-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1338602112
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: