Provider Demographics
NPI:1679391932
Name:HARTWELL, CALYNN RIESE
Entity type:Individual
Prefix:
First Name:CALYNN
Middle Name:RIESE
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 118TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3621
Mailing Address - Country:US
Mailing Address - Phone:918-638-2258
Mailing Address - Fax:
Practice Address - Street 1:208 E 118TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3621
Practice Address - Country:US
Practice Address - Phone:918-638-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program