Healthcare Provider Details

I. General information

NPI: 1114918554
Provider Name (Legal Business Name): NICOLE ELYSE HARDY CRNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 ADAMS DR UNIT B
HUMMELSTOWN PA
17036
US

IV. Provider business mailing address

4474 NANTUCKET RD STE 2F
HARRISBURG PA
17112-1932
US

V. Phone/Fax

Practice location:
  • Phone: 717-482-8115
  • Fax:
Mailing address:
  • Phone: 717-756-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP008575
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010481
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103090022
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: