Provider Demographics
NPI:1558890517
Name:HARDWICK, CHASE (NP)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST.
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-615-5864
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 SPRUCE ST.
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-615-5864
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY431271363LA2200X
PASP025641363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health