Provider Demographics
NPI:1144494774
Name:HARTWIG, NADINE JO (NP-C)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:JO
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 DEVON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1017
Practice Address - Country:US
Practice Address - Phone:256-604-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-040411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-93828OtherBCBS OF ALABAMA
AL510I500312OtherMEDICARE
AL510-50070OtherBCBS OF ALABAMA
AL515-93829OtherBCBS OF ALABAMA
AL111645Medicaid
AL515-95464OtherBCBS OF ALABAMA
AL528701110Medicaid
AL515-95257OtherBCBS OF ALABAMA
ALCA0084OtherRR MEDICARE
AL515-93827OtherBCBS OF ALABAMA
AL515-92876OtherBCBS OF ALABAMA