Healthcare Provider Details

I. General information

NPI: 1376073460
Provider Name (Legal Business Name): MARI CATHERINE HAMM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 ANDERSON FERRY RD
CINCINNATI OH
45238-3328
US

IV. Provider business mailing address

2170 ANDERSON FERRY RD
CINCINNATI OH
45238-3328
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-4271
  • Fax:
Mailing address:
  • Phone: 513-922-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3010871
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0029554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: