Basic Information
| Provider Information | |||||||||
| NPI: | 1336137405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTMAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036029137 | ||||||||
| FaxNumber: | 3036029136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S POTOMAC ST | ||||||||
| Address2: | #225 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800124514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038735245 | ||||||||
| FaxNumber: | 3038735240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 05/25/2012 | ||||||||
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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 | 367A00000X | 129621 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 23175800 | 05 | CO | MEDICAID |