Provider Demographics
NPI:1902818495
Name:HARDWICK, CHRISTINA R (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-497-1920
Mailing Address - Fax:317-497-6801
Practice Address - Street 1:606 BLACK RIVER RD STE 300
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3304
Practice Address - Country:US
Practice Address - Phone:843-652-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01179048OtherRR MEDICARE PTAN
INP01179048OtherRR MEDICARE PTAN
P68719Medicare UPIN
IN339250RRRRMedicare ID - Type UnspecifiedMCARE #