Healthcare Provider Details

I. General information

NPI: 1295646008
Provider Name (Legal Business Name): MIESHA HAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 S STATE ST
DOVER DE
19901-6925
US

IV. Provider business mailing address

1074 S STATE ST
DOVER DE
19901-6925
US

V. Phone/Fax

Practice location:
  • Phone: 302-719-8544
  • Fax:
Mailing address:
  • Phone: 302-719-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05951400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL2-0024115
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: