Provider Demographics
NPI:1740063973
Name:HARDY, CAREN SUE
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:SUE
Last Name:HARDY
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 1:12105 LINDQUIST RD
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-8314
Mailing Address - Country:US
Mailing Address - Phone:218-263-8710
Mailing Address - Fax:
Practice Address - Street 1:12105 LINDQUIST RD
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-8314
Practice Address - Country:US
Practice Address - Phone:218-263-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1120347177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging