Provider Demographics
NPI:1902431471
Name:HARDY, HOLLY MAE (DNAP, CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MAE
Last Name:HARDY
Suffix:
Gender:F
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MAE
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-0551
Mailing Address - Country:US
Mailing Address - Phone:573-248-1300
Mailing Address - Fax:
Practice Address - Street 1:6000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6887
Practice Address - Country:US
Practice Address - Phone:573-248-5115
Practice Address - Fax:573-248-5196
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015004677163W00000X
MO2020024175367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse