Basic Information
| Provider Information | |||||||||
| NPI: | 1184779928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDT | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RDMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6908 WESTSIDE SAGINAW RD | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487069377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896862572 | ||||||||
| FaxNumber: | 9896862613 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486012551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899078000 | ||||||||
| FaxNumber: | 9899077773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471S1302X | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography |
No ID Information.