Healthcare Provider Details

I. General information

NPI: 1679809115
Provider Name (Legal Business Name): SHANNON MARIA HAMMER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 10/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

17 WALNUT MILL LN
CLEONA PA
17042-3269
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax:
Mailing address:
  • Phone: 717-926-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH069625
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: