Provider Demographics
NPI:1356438345
Name:HARDY-GOMEZ, MARLENE E (CNP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:E
Last Name:HARDY-GOMEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:E
Other - Last Name:LAVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:6847 N CHESTNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-297-3882
Mailing Address - Fax:330-297-9841
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-3343
Practice Address - Fax:330-543-3539
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08047-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner