Healthcare Provider Details

I. General information

NPI: 1356972897
Provider Name (Legal Business Name): NICOLE HAMMES RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 HERNDON AVE
CLOVIS CA
93611-8976
US

IV. Provider business mailing address

2497 HERNDON AVE
CLOVIS CA
93611-8976
US

V. Phone/Fax

Practice location:
  • Phone: 559-900-7133
  • Fax: 559-854-1013
Mailing address:
  • Phone: 559-900-7133
  • Fax: 559-854-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA69709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: