Basic Information
| Provider Information | |||||||||
| NPI: | 1265496368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTSOCK | ||||||||
| FirstName: | BETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 FRANKLIN HEALTH CMNS | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049386142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077784922 | ||||||||
| FaxNumber: | 2077790646 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 FRANKLIN HEALTH CMNS | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049386142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077784922 | ||||||||
| FaxNumber: | 2077790646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R041286 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | CNP81586 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 254880099 | 05 | ME | MEDICAID |