Healthcare Provider Details

I. General information

NPI: 1144576901
Provider Name (Legal Business Name): LAURA ELIZABETH HARTMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MITCHELLVILLE RD STE 102
BOWIE MD
20716-3175
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 220
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-5900
  • Fax: 410-741-0865
Mailing address:
  • Phone: 410-729-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR177301
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: