Provider Demographics
NPI:1821303892
Name:HARDING, MATILDA A (PHLEBOTOMY)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:A
Last Name:HARDING
Suffix:
Gender:F
Credentials:PHLEBOTOMY
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1956 INDIAN HILL LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-3638
Mailing Address - Country:US
Mailing Address - Phone:630-800-1127
Mailing Address - Fax:
Practice Address - Street 1:1956 INDIAN HILL LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-3638
Practice Address - Country:US
Practice Address - Phone:630-800-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U000000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory