Provider Demographics
NPI:1326566175
Name:HARDEE, DIANE ROSE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ROSE
Last Name:HARDEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:ROSE
Other - Last Name:ANTONYSHYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:460 SOUTH ELIOT AVE.
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:320-358-0987
Mailing Address - Fax:320-358-3422
Practice Address - Street 1:460 SOUT ELIOT AVE.
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-0987
Practice Address - Fax:320-358-3422
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1216576163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse