Healthcare Provider Details

I. General information

NPI: 1285521260
Provider Name (Legal Business Name): EMMA HARDINA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 NASH WAY MAILSTOP: 90-29-928
ST. LOUIS MO
63110
US

IV. Provider business mailing address

1315 CENTERPOINT CIR APT 306
O FALLON IL
62269-2168
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1930
  • Fax:
Mailing address:
  • Phone: 928-279-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2025025833
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: