Healthcare Provider Details

I. General information

NPI: 1730502162
Provider Name (Legal Business Name): KRISTINA HAMMER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE STE 201
ALBUQUERQUE NM
87109-1233
US

IV. Provider business mailing address

11300 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-4112
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-0443
  • Fax: 505-888-1398
Mailing address:
  • Phone: 505-314-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2013-0088
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: