Healthcare Provider Details

I. General information

NPI: 1043320930
Provider Name (Legal Business Name): JOHANNA M HARTLEIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV NEUROLOGY MOVEMENT DISORDERS, 7TH FL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6908
  • Fax: 314-747-3258
Mailing address:
  • Phone: 314-362-6908
  • Fax: 314-747-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number155903
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: