Healthcare Provider Details

I. General information

NPI: 1003275637
Provider Name (Legal Business Name): STACY JOY HAMMER RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39648 RES HWY 3
MORTON MN
56270
US

IV. Provider business mailing address

39648 RES HWY 3
MORTON MN
56270
US

V. Phone/Fax

Practice location:
  • Phone: 507-697-8600
  • Fax: 507-697-8911
Mailing address:
  • Phone: 507-697-8600
  • Fax: 507-697-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: