Provider Demographics
NPI:1528089323
Name:HARTMAN, SHANNON PAGE (CRNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAGE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 KENDLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1614
Mailing Address - Country:US
Mailing Address - Phone:301-223-1241
Mailing Address - Fax:
Practice Address - Street 1:17812 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1709
Practice Address - Country:US
Practice Address - Phone:301-582-0133
Practice Address - Fax:301-582-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD824211OtherMAMSI
MD156M139FMedicare ID - Type Unspecified
MD824211OtherMAMSI