1497746804 NPI number — MARY LOUISE HARDEN A.R.N.P.

Table of content: MARY LOUISE HARDEN A.R.N.P. (NPI 1497746804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497746804 NPI number — MARY LOUISE HARDEN A.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDEN
Provider First Name:
MARY LOUISE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497746804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33911-7151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-939-3303
Provider Business Mailing Address Fax Number:
239-939-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4535 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-629-9700
Provider Business Practice Location Address Fax Number:
941-629-5800
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  ARNP1269782 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)