Provider Demographics
NPI:1366586380
Name:HARDY, NOLA M (RD)
Entity type:Individual
Prefix:
First Name:NOLA
Middle Name:M
Last Name:HARDY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 OAK ST
Mailing Address - Street 2:APT 8
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1724
Mailing Address - Country:US
Mailing Address - Phone:715-735-4609
Mailing Address - Fax:
Practice Address - Street 1:3130 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4291
Practice Address - Country:US
Practice Address - Phone:715-735-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1991-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI963997OtherDIETETIC REGISTRATION