Basic Information
Provider Information
NPI: 1477942894
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARDY
FirstName: RHONDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSN, NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 W UNIVERSITY AVE
Address2:  
City: CHAMPAIGN
State: IL
PostalCode: 618203909
CountryCode: US
TelephoneNumber: 2173668107
FaxNumber:  
Practice Location
Address1: 3545 N VERMILION ST
Address2:  
City: DANVILLE
State: IL
PostalCode: 618321100
CountryCode: US
TelephoneNumber: 2174428611
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/22/2015
LastUpdateDate: 01/06/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209.012339ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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