Provider Demographics
NPI:1134464803
Name:HARDY, CATHERINE ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:HARDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1747
Mailing Address - Country:US
Mailing Address - Phone:315-265-4065
Mailing Address - Fax:315-265-0012
Practice Address - Street 1:56 MARKET ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1747
Practice Address - Country:US
Practice Address - Phone:315-265-4065
Practice Address - Fax:315-265-0012
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278868-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse