Provider Demographics
NPI:1487274833
Name:HARDY, AMIRAH A (CNA)
Entity type:Individual
Prefix:MS
First Name:AMIRAH
Middle Name:A
Last Name:HARDY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1115
Mailing Address - Country:US
Mailing Address - Phone:702-268-7720
Mailing Address - Fax:702-920-9405
Practice Address - Street 1:3560 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1115
Practice Address - Country:US
Practice Address - Phone:702-268-7720
Practice Address - Fax:702-920-9405
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1477991040Medicaid