Basic Information
| Provider Information | |||||||||
| NPI: | 1407307473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTGROVE | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5175 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432132425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145751200 | ||||||||
| FaxNumber: | 6145759405 | ||||||||
| Practice Location | |||||||||
| Address1: | 5175 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145751200 | ||||||||
| FaxNumber: | 6145759405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 09/06/2018 | ||||||||
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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 | 363LF0000X | F0916863 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.