Healthcare Provider Details

I. General information

NPI: 1497273114
Provider Name (Legal Business Name): WINSOME MARIE HARDIE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 09 CANEY ROAD
ROSEDALE NY
11422-2313
US

IV. Provider business mailing address

24109 CANEY RD
ROSEDALE NY
11422-2313
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-9445
  • Fax: 718-949-9445
Mailing address:
  • Phone: 347-512-3392
  • Fax: 718-949-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number791943-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: