Individual
MS. THERESA E. HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.N.P.,IBCLC
Contact information
Practice address
1112 W DANIEL ST, CHAMPAIGN, IL 61821-4516
(217) 552-1101
(888) 965-5344
Mailing address
1112 W DANIEL ST, CHAMPAIGN, IL 61821-4516
(217) 552-1101
(888) 965-5344
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277000270
IL
363L00000X
Nurse Practitioner
377000270
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
433990
MEDICARE GROUP
—
Enumeration date
08/01/2006
Last updated
12/16/2019
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