Provider Demographics
NPI:1497273114
Name:HARDIE, WINSOME MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:WINSOME
Middle Name:MARIE
Last Name:HARDIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24109 CANEY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2313
Mailing Address - Country:US
Mailing Address - Phone:347-512-3392
Mailing Address - Fax:718-949-9445
Practice Address - Street 1:241 09 CANEY ROAD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2313
Practice Address - Country:US
Practice Address - Phone:718-949-9445
Practice Address - Fax:718-949-9445
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295144-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse