Provider Demographics
NPI:1699404301
Name:HARDING, NICOLE ANGELA (COS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELA
Last Name:HARDING
Suffix:
Gender:F
Credentials:COS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S. MAIN CHAPEL WAY
Mailing Address - Street 2:STE. 104 #687
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:443-679-7879
Mailing Address - Fax:
Practice Address - Street 1:328 HIGHLAND DR APT 104
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6099
Practice Address - Country:US
Practice Address - Phone:443-679-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
435139224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist