Provider Demographics
NPI:1487766036
Name:HATTENBRUN, DAVID LLOYD IV (FNP/ANP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LLOYD
Last Name:HATTENBRUN
Suffix:IV
Gender:M
Credentials:FNP/ANP
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:LLOYD
Other - Last Name:HATTENBRUN
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC, ANP-BC
Mailing Address - Street 1:222 ROUTE 299
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2524
Mailing Address - Country:US
Mailing Address - Phone:845-691-3627
Mailing Address - Fax:845-691-3641
Practice Address - Street 1:222 ROUTE 299
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2524
Practice Address - Country:US
Practice Address - Phone:845-691-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF333066OtherNYS NP LICENSE
NYQO9822Medicare UPIN