Healthcare Provider Details

I. General information

NPI: 1952848590
Provider Name (Legal Business Name): MARLA B HARDY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 W CENTRAL AVE
LOVINGTON NM
88260-3723
US

IV. Provider business mailing address

1822 W CENTRAL AVE
LOVINGTON NM
88260-3723
US

V. Phone/Fax

Practice location:
  • Phone: 575-631-1477
  • Fax:
Mailing address:
  • Phone: 575-631-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03145
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: