Healthcare Provider Details

I. General information

NPI: 1083256911
Provider Name (Legal Business Name): NICOLE M HAMMOND NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL ST FL 6
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

810 WILDA DR
WESTMINSTER MD
21157-8352
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9002
  • Fax: 410-659-1107
Mailing address:
  • Phone: 443-388-1242
  • Fax: 410-659-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR214425
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: