Provider Demographics
NPI:1659975316
Name:HARDEE, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:HARDEE
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 1:201 CHAPMAN RD APT B3
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-6162
Mailing Address - Country:US
Mailing Address - Phone:864-408-9830
Mailing Address - Fax:
Practice Address - Street 1:201 CHAPMAN RD APT B3
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-6162
Practice Address - Country:US
Practice Address - Phone:864-408-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider