Provider Demographics
NPI:1578097119
Name:HARTMAN, AMANDA C (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6995 LINDA VISTA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1073
Mailing Address - Country:US
Mailing Address - Phone:406-926-1300
Mailing Address - Fax:
Practice Address - Street 1:6995 LINDA VISTA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1073
Practice Address - Country:US
Practice Address - Phone:406-926-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61133320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine