1750479838 NPI number — DR. STEPHANIE RENAE HARDY OD

Table of content: DR. STEPHANIE RENAE HARDY OD (NPI 1750479838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750479838 NPI number — DR. STEPHANIE RENAE HARDY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDY
Provider First Name:
STEPHANIE
Provider Middle Name:
RENAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORTESE
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750479838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHALLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28459-0867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-754-2020
Provider Business Mailing Address Fax Number:
910-754-8811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4830 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHALLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28470-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-754-2020
Provider Business Practice Location Address Fax Number:
910-754-8811
Provider Enumeration Date:
10/11/2006

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: 152W00000X , with the licence number:  2085 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NC2164A . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5909229 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com