Healthcare Provider Details

I. General information

NPI: 1770007197
Provider Name (Legal Business Name): LORRAINE MARIE HARDY MSN RN AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL STE 102
RIVERSIDE RI
02915-2233
US

IV. Provider business mailing address

110 ELM STREET
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4010
  • Fax: 401-649-4011
Mailing address:
  • Phone: 877-771-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN01720
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN252429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: