Healthcare Provider Details

I. General information

NPI: 1831351196
Provider Name (Legal Business Name): VIRGINIA C HARDIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 W. HORIZON RIDGE PKWY.
HENDERSON NV
89012-4833
US

IV. Provider business mailing address

1748 W. HORIZON RIDGE PKWY.
HENDERSON NV
89012-4833
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-1300
  • Fax: 702-728-5661
Mailing address:
  • Phone: 702-982-1300
  • Fax: 702-728-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25955
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5839
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number18489
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: