Provider Demographics
NPI:1336916337
Name:HARDIN, ELLEN S (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:HISSONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:1212 E STATE ROUTE 72 STE 8
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3984
Practice Address - Country:US
Practice Address - Phone:573-308-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001262029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse