Healthcare Provider Details

I. General information

NPI: 1487772760
Provider Name (Legal Business Name): TERESA JO HARDESTY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23399 NEW GUILFORD RD
MARTINSBURG OH
43037-9202
US

IV. Provider business mailing address

23399 NEW GUILFORD RD
MARTINSBURG OH
43037-9202
US

V. Phone/Fax

Practice location:
  • Phone: 740-668-4023
  • Fax:
Mailing address:
  • Phone: 740-668-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 081058
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: