Provider Demographics
NPI:1851601736
Name:HARDESTY, MICHELLE (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 E SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4313
Mailing Address - Country:US
Mailing Address - Phone:602-391-9623
Mailing Address - Fax:
Practice Address - Street 1:1381 E SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4313
Practice Address - Country:US
Practice Address - Phone:602-391-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP3815163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice