Provider Demographics
NPI:1275359101
Name:HARDWARE, DENASHA LAVON
Entity type:Individual
Prefix:
First Name:DENASHA
Middle Name:LAVON
Last Name:HARDWARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENASHA
Other - Middle Name:LAVON
Other - Last Name:RANGOLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7041
Mailing Address - Country:US
Mailing Address - Phone:864-965-8418
Mailing Address - Fax:
Practice Address - Street 1:1305 PHYLLIS DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7041
Practice Address - Country:US
Practice Address - Phone:864-965-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist