Provider Demographics
NPI:1457135667
Name:HARDISON, SARINA DONYELL
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:DONYELL
Last Name:HARDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855R BEDFORD ST APT A
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1847
Mailing Address - Country:US
Mailing Address - Phone:814-691-4113
Mailing Address - Fax:
Practice Address - Street 1:2855R BEDFORD ST APT A
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1847
Practice Address - Country:US
Practice Address - Phone:814-691-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAH8J7W5W4374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician