Basic Information
| Provider Information | |||||||||
| NPI: | 1659742724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN,MSN,APN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARDY | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2007 N BLACK HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080949120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567404888 | ||||||||
| FaxNumber: | 8567400559 | ||||||||
| Practice Location | |||||||||
| Address1: | 1171 TREASURE LN | ||||||||
| Address2: | |||||||||
| City: | WEST DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080931964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092214884 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NO11463500 | NJ | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 26NJ00630200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 26NO11463500 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.