Provider Demographics
NPI:1043457294
Name:HARDIE, JEANNE ANNE (M D)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ANNE
Last Name:HARDIE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WEKIU PL
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2916
Mailing Address - Country:US
Mailing Address - Phone:808-661-7860
Mailing Address - Fax:
Practice Address - Street 1:395 WEKIU PL
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2916
Practice Address - Country:US
Practice Address - Phone:808-661-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7838208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice