Provider Demographics
NPI:1649559063
Name:HARDY LUKAS, ALISA (NP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:HARDY LUKAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 PARRISH STREET
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1794
Mailing Address - Country:US
Mailing Address - Phone:585-393-2888
Mailing Address - Fax:585-919-2547
Practice Address - Street 1:345 N MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2508
Practice Address - Country:US
Practice Address - Phone:860-236-3000
Practice Address - Fax:860-232-2746
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360551363LX0001X
CT2479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology