Healthcare Provider Details

I. General information

NPI: 1669063574
Provider Name (Legal Business Name): MELISSA D HARTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 WALNUT ST.
FRANKLIN WV
26807-0888
US

IV. Provider business mailing address

109 S COLLEGE ST
MARTINSBURG WV
25401-3307
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax:
Mailing address:
  • Phone: 304-267-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number62974
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: