Provider Demographics
NPI:1316018427
Name:HARDEMAN, SUZANNE M (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARLOW
Other - Last Name:HARDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL PARK
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8903
Mailing Address - Country:US
Mailing Address - Phone:803-434-4300
Mailing Address - Fax:803-434-4351
Practice Address - Street 1:15 MEDICAL PARK
Practice Address - Street 2:SUITE 141
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8903
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4351
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4747101YP2500X
SC3152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1361Medicaid
SCNP1361Medicaid