Provider Demographics
NPI:1609944743
Name:HARDESTY, ANDREA S (ARNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3010
Mailing Address - Country:US
Mailing Address - Phone:425-445-0600
Mailing Address - Fax:
Practice Address - Street 1:1902 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3010
Practice Address - Country:US
Practice Address - Phone:425-445-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011129174400000X
WAAP61428157363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No174400000XOther Service ProvidersSpecialist