Provider Demographics
NPI:1801082615
Name:HARDMAN, KEVIN G (LMP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:HARDMAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4152 MERIDIAN ST
Mailing Address - Street 2:STE 105 PMB 154
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5598
Mailing Address - Country:US
Mailing Address - Phone:360-223-1602
Mailing Address - Fax:
Practice Address - Street 1:907 HARRIS AVE
Practice Address - Street 2:STE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7005
Practice Address - Country:US
Practice Address - Phone:360-223-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist