Basic Information
| Provider Information | |||||||||
| NPI: | 1114918554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ELYSE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4474 NANTUCKET RD STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171121932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177564547 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8105 ADAMS DR UNIT B | ||||||||
| Address2: | |||||||||
| City: | HUMMELSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174828115 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | SP008575 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | MW010481 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 103090022 | 05 | PA | MEDICAID |