Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 2721-033 | WI |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2721-033 | WI |
NPI | 1003086703 |
---|---|
Provider Name | Alane Renee Hartlage |
First Address | Fitchburg, WI 53711-4929 |
Second Address | Minnetonka, MN 55343-9664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 26/06/2020 |