| Doctor Name: | NICOLE MARIE HARDY |
| NPI Number: | 1205110095 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, MSN, CPNP-PC |
| License Number: | 731343 |
| Business Practice Address: | 405 N Maclay Ave 104 San Fernando, CA - 913402445 |
| Business Phone Number: | 8183613318 |
| Business Fax Number: | 8183617309 |
| Mailing Address: | 405 N Maclay Ave, 104 SAN FERNANDO |
| State: | CA |
| Postal Code: | 913402445 |
| Phone Number: | 8183613318 |
| Fax Number: | 8183617309 |
| NPI Enumeration Date: | 09/28/2011 |
| NPI Last Update Date: | 09/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 731343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |