Provider Demographics
NPI:1679181267
Name:HARDIE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HARDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CARCHEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 E MCKINLEY WAY
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2047
Mailing Address - Country:US
Mailing Address - Phone:330-398-9179
Mailing Address - Fax:
Practice Address - Street 1:904 SAHARA TRL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3695
Practice Address - Country:US
Practice Address - Phone:330-758-9787
Practice Address - Fax:330-758-9792
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027035363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner