Healthcare Provider Details

I. General information

NPI: 1477764645
Provider Name (Legal Business Name): MICHELLE LYNN HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 MILLCHOP LN
MAGNOLIA DE
19962-1750
US

IV. Provider business mailing address

1311 MILLCHOP LN
MAGNOLIA DE
19962-1750
US

V. Phone/Fax

Practice location:
  • Phone: 302-423-5257
  • Fax:
Mailing address:
  • Phone: 302-423-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0035106
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: