Healthcare Provider Details

I. General information

NPI: 1306166772
Provider Name (Legal Business Name): MARY HAMM ARNP/CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK RD SUITE 200
CINCINNATI OH
45227-2172
US

IV. Provider business mailing address

4460 RED BANK RD SUITE 200
CINCINNATI OH
45227-2172
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-4333
  • Fax: 513-232-0100
Mailing address:
  • Phone: 513-321-4333
  • Fax: 513-232-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.09858-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: