Provider Demographics
NPI:1710267877
Name:HARDIN-REYNOLDS, TRUDY L (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:L
Last Name:HARDIN-REYNOLDS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N. MARIO CAPECCHI DRIVE
Mailing Address - Street 2:PEDIATRIC CRITICAL CARE SERVICES
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1100
Mailing Address - Country:US
Mailing Address - Phone:801-662-2400
Mailing Address - Fax:801-662-2412
Practice Address - Street 1:825 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3320
Practice Address - Country:US
Practice Address - Phone:801-355-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176676-4405363L00000X
UT176676-8900363L00000X
UTMH2422373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner