Provider Demographics
NPI:1023363769
Name:HARDY, SHANNON (DHAT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:FORT YUKON
Mailing Address - State:AK
Mailing Address - Zip Code:99740
Mailing Address - Country:US
Mailing Address - Phone:907-662-7531
Mailing Address - Fax:907-662-2709
Practice Address - Street 1:309 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740
Practice Address - Country:US
Practice Address - Phone:907-662-7531
Practice Address - Fax:907-662-2709
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other