Provider Demographics
NPI:1114510310
Name:HARDEY, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:HARDEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20715 TIMBERLAKE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7217
Mailing Address - Country:US
Mailing Address - Phone:434-509-0460
Mailing Address - Fax:
Practice Address - Street 1:20715 TIMBERLAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7217
Practice Address - Country:US
Practice Address - Phone:434-509-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist