Healthcare Provider Details

I. General information

NPI: 1942746201
Provider Name (Legal Business Name): HEATHER NICOLE HAMMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HEATHER NICOLE BACH

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4830
  • Fax: 513-636-7868
Mailing address:
  • Phone: 513-636-4830
  • Fax: 513-636-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.17985
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.17985
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: