Healthcare Provider Details

I. General information

NPI: 1497057061
Provider Name (Legal Business Name): LINDA HAMMONS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

3443 VILLA LN STE 6
NAPA CA
94558-6417
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-8711
  • Fax:
Mailing address:
  • Phone: 707-252-8407
  • Fax: 707-252-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number318755
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: