Healthcare Provider Details

I. General information

NPI: 1649640814
Provider Name (Legal Business Name): ALEAH KRISTIN HARTUNG DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 LONGLEY LN STE 60
RENO NV
89511-1239
US

IV. Provider business mailing address

960 CAUGHLIN XING #100
RENO NV
89519-0611
US

V. Phone/Fax

Practice location:
  • Phone: 775-453-6072
  • Fax:
Mailing address:
  • Phone: 775-348-9798
  • Fax: 775-348-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52441
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1641
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: