Provider Demographics
NPI:1770007197
Name:HARDY, LORRAINE MARIE (MSN RN AGNP-BC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARIE
Last Name:HARDY
Suffix:
Gender:F
Credentials:MSN RN AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:877-771-7401
Mailing Address - Fax:
Practice Address - Street 1:375 WAMPANOAG TRL STE 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2233
Practice Address - Country:US
Practice Address - Phone:401-649-4010
Practice Address - Fax:401-649-4011
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN252429163W00000X
RIAPRN01720363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse