Provider Demographics
NPI:1851601736
Name:HARDESTY, MICHELLE (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-1626
Mailing Address - Country:US
Mailing Address - Phone:928-243-7157
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1626
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-1626
Practice Address - Country:US
Practice Address - Phone:928-243-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3815363LF0000X
AZTAP3815163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice