Healthcare Provider Details

I. General information

NPI: 1508214511
Provider Name (Legal Business Name): SAMANTHA ANN HAMMER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12142 BUSINESS PARK BLVD N
CHAMPLIN MN
55316-4525
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-977-0500
  • Fax:
Mailing address:
  • Phone: 952-977-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2531
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12169
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: