Healthcare Provider Details

I. General information

NPI: 1033139381
Provider Name (Legal Business Name): ANNEMARIE R HARDY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

2131 N 84TH ST
WAUWATOSA WI
53226-2824
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-389-4198
Mailing address:
  • Phone: 414-771-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number875719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: