Individual
DR. JOHNA C HARTNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10 NORTH RIVER ROAD, PHS INDIAN HEALTH SERVICE, FORT YATES, ND 58538-0797
(701) 854-3831
(701) 854-3844
Mailing address
PO BOX J, PHS INDIAN HEALTH SERVICE, DIR. BEHAVIORAL HEALTH, FORT YATES, ND 58538-0527
(701) 854-8276
(701) 854-3844
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0035
NM
103T00000X
Psychologist
1116-57
WI
103T00000X
Psychologist
1129
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000684106
MEDICARE
WI
05
—
39035300
—
WI
05
—
81613
—
ND
01
—
HSZI31ZJSB
INDIAN HEALTH SERVICE
ND
Enumeration date
07/31/2006
Last updated
07/29/2015
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