Provider Demographics
NPI:1841483518
Name:RICHARDS-HARDY, JANN LYNN (CN)
Entity type:Individual
Prefix:MS
First Name:JANN
Middle Name:LYNN
Last Name:RICHARDS-HARDY
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PICCADILLY ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22824-9704
Mailing Address - Country:US
Mailing Address - Phone:540-333-0695
Mailing Address - Fax:
Practice Address - Street 1:206 PICCADILLY ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:VA
Practice Address - Zip Code:22824-9704
Practice Address - Country:US
Practice Address - Phone:540-333-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000570133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist