Provider Demographics
NPI:1932843927
Name:HARDY, MYRANDA LATRECE
Entity Type:Individual
Prefix:
First Name:MYRANDA
Middle Name:LATRECE
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 1:1143 SOUTHVIEW DR APT 102
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3443
Mailing Address - Country:US
Mailing Address - Phone:202-845-0261
Mailing Address - Fax:
Practice Address - Street 1:222 M ST SW APT 505
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3742
Practice Address - Country:US
Practice Address - Phone:202-271-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant