Provider Demographics
NPI:1639418635
Name:HARTMAN, MICHELLE DIANE (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 SULLIVAN SLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9013
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:319-758-6650
Practice Address - Street 1:4715 SULLIVAN SLOUGH RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9013
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:319-758-6650
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001203363LF0000X
IA091591163W00000X
IL041333534163W00000X
IAA091591363LF0000X
IAG183675363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse