Provider Demographics
NPI:1235907304
Name:HARDIMAN, MICHAIAH
Entity Type:Individual
Prefix:
First Name:MICHAIAH
Middle Name:
Last Name:HARDIMAN
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 1:255 W TAMI CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-9097
Mailing Address - Country:US
Mailing Address - Phone:313-698-6605
Mailing Address - Fax:
Practice Address - Street 1:255 W TAMI CIR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-9097
Practice Address - Country:US
Practice Address - Phone:313-698-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide