Individual
ELLYN W. HARTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
5525 GROSSMONT CENTER DR, LA MESA, CA 91942-3009
(619) 644-6905
Mailing address
5525 GROSSMONT CENTER DR, LA MESA, CA 91942-3009
(619) 644-6905
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN225948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN225948
—
CA
Enumeration date
08/08/2006
Last updated
07/08/2007
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