Healthcare Provider Details

I. General information

NPI: 1740879436
Provider Name (Legal Business Name): BROOKE HALEY HAMMOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 EXCHANGE GLENWOOD PL APT 413
RALEIGH NC
27612-4860
US

IV. Provider business mailing address

3710 EXCHANGE GLENWOOD PL APT 413
RALEIGH NC
27612-4860
US

V. Phone/Fax

Practice location:
  • Phone: 407-670-4222
  • Fax:
Mailing address:
  • Phone: 407-670-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9521104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: