Provider Demographics
NPI:1316498868
Name:HARDIN, MARYNELL (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARYNELL
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GRAMMONT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7411
Mailing Address - Country:US
Mailing Address - Phone:318-966-6300
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST STE 410
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-966-6300
Practice Address - Fax:318-966-6301
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO8836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily