Provider Demographics
NPI:1437474764
Name:HARDY, LUCRETIA LATRICE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LUCRETIA
Middle Name:LATRICE
Last Name:HARDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 CASANN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4820
Mailing Address - Country:US
Mailing Address - Phone:901-570-7861
Mailing Address - Fax:
Practice Address - Street 1:4711 CASANN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-4820
Practice Address - Country:US
Practice Address - Phone:901-570-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000168682163W00000X
TNOOOOO50827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse