Provider Demographics
NPI:1629322623
Name:HARDY, JENNIFER ANN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:SLOAN
Mailing Address - State:NY
Mailing Address - Zip Code:14212-2306
Mailing Address - Country:US
Mailing Address - Phone:716-563-6149
Mailing Address - Fax:
Practice Address - Street 1:61 ROLAND STREET
Practice Address - Street 2:
Practice Address - City:SLOAN
Practice Address - State:NY
Practice Address - Zip Code:14212-2306
Practice Address - Country:US
Practice Address - Phone:716-563-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296476-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid