Healthcare Provider Details

I. General information

NPI: 1871513259
Provider Name (Legal Business Name): MICHELLE HARDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 2ND ST NW
BEACH ND
58621
US

IV. Provider business mailing address

30 7TH ST W
DICKINSON ND
58601-4335
US

V. Phone/Fax

Practice location:
  • Phone: 701-872-3777
  • Fax: 701-872-3419
Mailing address:
  • Phone: 701-456-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR22686
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: