Healthcare Provider Details

I. General information

NPI: 1124660667
Provider Name (Legal Business Name): CASSANDRA ELIZABETH HARDIN CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

252 BUCKINGHAM RD
CANTON MI
48188-1515
US

V. Phone/Fax

Practice location:
  • Phone: 734-765-5574
  • Fax:
Mailing address:
  • Phone: 734-765-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209020372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041486106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: