Provider Demographics
NPI:1255754214
Name:HARDY, LYNOR DICANG (IDMT)
Entity type:Individual
Prefix:
First Name:LYNOR
Middle Name:DICANG
Last Name:HARDY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 POWELL PT
Mailing Address - Street 2:APT 206
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2860
Mailing Address - Country:US
Mailing Address - Phone:850-240-3552
Mailing Address - Fax:
Practice Address - Street 1:CHEYENNE MOUNTAIN AIR STATION
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922
Practice Address - Country:US
Practice Address - Phone:850-240-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians