Healthcare Provider Details

I. General information

NPI: 1700381407
Provider Name (Legal Business Name): MARC HARTUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MAIN ST
ELMA WA
98541-9560
US

IV. Provider business mailing address

600 E MAIN ST
ELMA WA
98541-9560
US

V. Phone/Fax

Practice location:
  • Phone: 360-495-5647
  • Fax: 360-346-2192
Mailing address:
  • Phone: 808-344-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61421852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: