Provider Demographics
NPI:1114918554
Name:HARDY, NICOLE ELYSE (CRNP, CNM)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ELYSE
Last Name:HARDY
Suffix:
Gender:F
Credentials:CRNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 NANTUCKET RD STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1932
Mailing Address - Country:US
Mailing Address - Phone:717-756-4547
Mailing Address - Fax:
Practice Address - Street 1:8105 ADAMS DR UNIT B
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036
Practice Address - Country:US
Practice Address - Phone:717-482-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008575363LX0001X, 363LX0001X
PAMW010481367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103090022Medicaid
PA324830Medicare PIN