Basic Information
Provider Information | |||||||||
NPI: | 1932752037 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARTLEY | ||||||||
FirstName: | DIANNA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 39722 SMITH RD | ||||||||
Address2: |   | ||||||||
City: | SPENCER | ||||||||
State: | OH | ||||||||
PostalCode: | 442759602 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3305928100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 630 EAST RIVER ROAD | ||||||||
Address2: |   | ||||||||
City: | ELYRIA | ||||||||
State: | OH | ||||||||
PostalCode: | 43035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4403297500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2019 | ||||||||
LastUpdateDate: | 10/28/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 024692 | OH | N |   | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | APRN.CNP.024692 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 024692 | 01 | OH | CNP | OTHER |