Healthcare Provider Details

I. General information

NPI: 1609327238
Provider Name (Legal Business Name): DEBORAH HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SYCAMORE LINE
SANDUSKY OH
44870-4029
US

IV. Provider business mailing address

1939 CEMETERY RD
FREMONT OH
43420-3518
US

V. Phone/Fax

Practice location:
  • Phone: 419-625-5269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: