Healthcare Provider Details

I. General information

NPI: 1194146183
Provider Name (Legal Business Name): MELISSA DURHAM HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 MAPLE ST
GREENSBORO NC
27405-6910
US

IV. Provider business mailing address

1203 MAPLE ST
GREENSBORO NC
27405-6910
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-8069
  • Fax: 336-641-6971
Mailing address:
  • Phone: 336-641-8069
  • Fax: 336-641-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number189670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: