Provider Demographics
NPI:1306142534
Name:HARDY, PATRICIA BLAKE (LPN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BLAKE
Last Name:HARDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 SW SCHOLLS FERRY RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4070
Mailing Address - Country:US
Mailing Address - Phone:503-317-3335
Mailing Address - Fax:
Practice Address - Street 1:7240 SW SCHOLLS FERRY RD APT 2
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4070
Practice Address - Country:US
Practice Address - Phone:503-317-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030515LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse