Provider Demographics
NPI:1679846927
Name:HARDIE, SALLY MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:MARIE
Last Name:HARDIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ALCORN ST APT C
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-2213
Mailing Address - Country:US
Mailing Address - Phone:651-399-3968
Mailing Address - Fax:
Practice Address - Street 1:140 ALCORN ST APT C
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-2213
Practice Address - Country:US
Practice Address - Phone:651-399-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195679163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine