Healthcare Provider Details

I. General information

NPI: 1932752037
Provider Name (Legal Business Name): DIANNA LYNN HARTLEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EAST RIVER ROAD
ELYRIA OH
43035
US

IV. Provider business mailing address

39722 SMITH RD
SPENCER OH
44275-9602
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7500
  • Fax:
Mailing address:
  • Phone: 330-592-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024692
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number024692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: