Provider Demographics
NPI:1932467545
Name:HARDY, CASSONDRA LEE
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:LEE
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 1:201 AUTUMN DR.
Mailing Address - Street 2:APT B
Mailing Address - City:STRYKER
Mailing Address - State:OH
Mailing Address - Zip Code:43557
Mailing Address - Country:US
Mailing Address - Phone:419-551-7699
Mailing Address - Fax:
Practice Address - Street 1:201 AUTUMN DR.
Practice Address - Street 2:APT B
Practice Address - City:STRYKER
Practice Address - State:OH
Practice Address - Zip Code:43557
Practice Address - Country:US
Practice Address - Phone:419-551-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2942016Medicaid