Healthcare Provider Details

I. General information

NPI: 1831449024
Provider Name (Legal Business Name): CHERON ROSE HARDY APRN, NP-C, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GALEN ST SE
WASHINGTON DC
20020-4913
US

IV. Provider business mailing address

1220 12TH ST SE
WASHINGTON DC
20003-3722
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-7160
  • Fax: 202-548-8600
Mailing address:
  • Phone: 202-715-7975
  • Fax: 202-544-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1037169
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: