Provider Demographics
NPI:1659674356
Name:HARDEMAN, TERANCE LEMONT (CRNA)
Entity Type:Individual
Prefix:
First Name:TERANCE
Middle Name:LEMONT
Last Name:HARDEMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-7009
Mailing Address - Country:US
Mailing Address - Phone:601-331-1808
Mailing Address - Fax:601-825-6020
Practice Address - Street 1:125 AMANDA DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-7009
Practice Address - Country:US
Practice Address - Phone:601-331-1808
Practice Address - Fax:601-825-6020
Is Sole Proprietor?:No
Enumeration Date:2010-12-19
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874872367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01233824OtherRAILROAD MEDICARE
MS302I436982Medicare PIN