Basic Information
| Provider Information | |||||||||
| NPI: | 1174085609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 COTTAGE PL | ||||||||
| Address2: | |||||||||
| City: | WEST NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024651525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174075676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1493 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021391047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176651000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LN92333 | MA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.