Provider Demographics
NPI:1467713016
Name:HARDY, KRISTIN SUE (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:SUE
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 1:2541 IRONWOOD DR
Mailing Address - Street 2:APT 115
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-8828
Mailing Address - Country:US
Mailing Address - Phone:608-215-3117
Mailing Address - Fax:
Practice Address - Street 1:2541 IRONWOOD DR
Practice Address - Street 2:APT 115
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-8828
Practice Address - Country:US
Practice Address - Phone:608-215-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189908-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse