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NPI Code Detail

MEDICARE: MS. MARCELLA L. HARDY-PETERSON NP

MEDICARE: MS. MARCELLA L. HARDY-PETERSON 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
1363LX0001XObstetrics & Gynecology Nurse Practitioner5835CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831138478
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARCELLA L. HARDY-PETERSON NP
Provider Business Mailing Address
First Line : 742 W HIGHLAND AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3839
Country : US
Telephone Number : 909-881-7320
Fax Number : 909-881-7330
Provider Business Practice Location Address
First Line : 742 W HIGHLAND AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3839
Country : US
Telephone Number : 909-881-7320
Fax Number : 909-881-7330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 02/14/2022

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