Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 26210 | NE |
N | 2082S0105X | Plastic Hand Surgeon | 26210 | NE |
NPI | 1184797110 |
---|---|
Provider Name | Tristan Layton Hartzell |
First Address | Norfolk, NE 68701-4401 |
Second Address | Norfolk, NE 68701-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 20/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099588036 | MEDICARE (01) | NE |
10025561800 | (05) | NE |
20079 | BCBS (01) | NE |