Healthcare Provider Details

I. General information

NPI: 1871085662
Provider Name (Legal Business Name): KATHERINE HARDIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HOEN AVE
SANTA ROSA CA
95405-7824
US

IV. Provider business mailing address

4700 HOEN AVE
SANTA ROSA CA
95405-7824
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-3360
  • Fax:
Mailing address:
  • Phone: 707-526-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: