Healthcare Provider Details

I. General information

NPI: 1245528827
Provider Name (Legal Business Name): OLGA VALERIEVNA HARDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLGA VALERIEVNA LATYPOVA MD

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

IV. Provider business mailing address

5021 VERNON AVE S # 131
EDINA MN
55436-2102
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1800
  • Fax:
Mailing address:
  • Phone: 952-428-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57765
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: