MEDICARE: NICOLE DAWN HARDMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1770181570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DAWN HARDMAN

Provider Business Mailing Address
First Line	:	533 S 4TH AVE
Second Line	:
City	:	PADEN CITY
State	:	WV
Zip	:	26159-1219
Country	:	US
Telephone Number	:	304-337-9230
Fax Number	:	304-337-9237

Provider Business Practice Location Address
First Line	:	533 S 4TH AVE
Second Line	:
City	:	PADEN CITY
State	:	WV
Zip	:	26159-1219
Country	:	US
Telephone Number	:	304-337-9230
Fax Number	:	304-337-9237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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Directions to “ NICOLE DAWN HARDMAN ” Practice Location

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