Provider Demographics
NPI:1477969632
Name:HARDY, RONNA L (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:L
Last Name:HARDY
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 A CORKHILL ROAD
Mailing Address - Street 2:APT 228
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3470
Mailing Address - Country:US
Mailing Address - Phone:216-310-6336
Mailing Address - Fax:
Practice Address - Street 1:561 CORKHILL RD # A
Practice Address - Street 2:APT 228
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3453
Practice Address - Country:US
Practice Address - Phone:216-310-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2646541172V00000X
OH109065-730264122113172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker