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TERANCE LEMONT HARDEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
125 AMANDA DR, PEARL, MS 39208-7009
(601) 331-1808
(601) 825-6020
Mailing address
125 AMANDA DR, PEARL, MS 39208-7009
(601) 331-1808
(601) 825-6020

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R874872
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P01233824
RAILROAD MEDICARE
MS
Enumeration date
12/19/2010
Last updated
12/16/2013
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