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NPI Code Detail

MEDICARE: ROBIN SULLIVAN HARDIN NP

MEDICARE: ROBIN SULLIVAN HARDIN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner812434MS

General Provider Information

NPI Number : 1649762253
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN SULLIVAN HARDIN NP
Provider Business Mailing Address
First Line : 1 MEDICAL LN
Second Line :
City : FOREST
State : MS
Zip : 39074-4039
Country : US
Telephone Number : 601-469-4861
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL LN
Second Line :
City : FOREST
State : MS
Zip : 39074-4039
Country : US
Telephone Number : 601-469-4861
Fax Number : 601-469-1238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2018
Last Update Date : 12/23/2019

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