Individual
MILES W HARTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
10420 OLD OLIVE STREET RD, CREVE COEUR, MO 63141-5914
(314) 692-8516
Mailing address
1301 MERRIAM PKWY, O FALLON, IL 62269-7096
(618) 792-6522
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
2013038580
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2019018504
MO
Other
Enumeration date
02/17/2019
Last updated
06/06/2019
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