Healthcare Provider Details

I. General information

NPI: 1659157485
Provider Name (Legal Business Name): JAIME HARTMAN NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 FRANCONIA COMMONS DR
ALEXANDRIA VA
22310-2567
US

IV. Provider business mailing address

6327 FRANCONIA COMMONS DR
ALEXANDRIA VA
22310-2567
US

V. Phone/Fax

Practice location:
  • Phone: 571-225-9828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3813721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: