Provider Demographics
NPI:1316765589
Name:HARDY, PAMELA MARLENE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARLENE
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2015
Mailing Address - Country:US
Mailing Address - Phone:313-623-1987
Mailing Address - Fax:
Practice Address - Street 1:21450 PARKLAWN ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3821
Practice Address - Country:US
Practice Address - Phone:248-906-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI76577443747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant