Healthcare Provider Details

I. General information

NPI: 1306503073
Provider Name (Legal Business Name): DR KRISTINA HAMMER MSPAC DMSC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-4112
US

IV. Provider business mailing address

11300 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-4112
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-4106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA HAMMER
Title or Position: OWNER
Credential:
Phone: 505-382-4106