Healthcare Provider Details

I. General information

NPI: 1164116638
Provider Name (Legal Business Name): AMBERLEY J HARDWICK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 W MAIN ST STE 330
RAPID CITY SD
57702-2435
US

IV. Provider business mailing address

7440 KINGBIRD CT
RAPID CITY SD
57702-9013
US

V. Phone/Fax

Practice location:
  • Phone: 303-895-1692
  • Fax:
Mailing address:
  • Phone: 303-895-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT11931
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: