Provider Demographics
NPI:1073324471
Name:HARDIN, ISABELLA GRACE (RD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:GRACE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NAUTICAL CHART DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8069
Mailing Address - Country:US
Mailing Address - Phone:828-764-5489
Mailing Address - Fax:
Practice Address - Street 1:295 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-970-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.3058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered