Provider Demographics
NPI:1144920786
Name:HARDGE, EDRICKA M
Entity type:Individual
Prefix:
First Name:EDRICKA
Middle Name:M
Last Name:HARDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24484 EASTWOOD VILLAGE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5852
Mailing Address - Country:US
Mailing Address - Phone:313-229-9985
Mailing Address - Fax:
Practice Address - Street 1:24484 EASTWOOD VILLAGE DR APT 106
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5852
Practice Address - Country:US
Practice Address - Phone:313-229-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator