Provider Demographics
NPI:1740823236
Name:HARDIN, CHANTAL (FNP)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-2010
Mailing Address - Country:US
Mailing Address - Phone:518-943-9100
Mailing Address - Fax:518-943-4437
Practice Address - Street 1:634 PLANK RD STE 106
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2033
Practice Address - Country:US
Practice Address - Phone:518-388-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily