MEDICARE: MR. MARK S HARTMAN RNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	42298655	MO

General Provider Information

NPI Number	:	1780352351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK S HARTMAN RNFA

Provider Business Mailing Address
First Line	:	405 SAVANNAH RIDGE DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-2918
Country	:	US
Telephone Number	:	636-244-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 S WOODS MILL RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3485
Country	:	US
Telephone Number	:	314-434-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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