Healthcare Provider Details

I. General information

NPI: 1992098065
Provider Name (Legal Business Name): HEIDI L HAMMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SHORE DR
RHINELANDER WI
54501-6710
US

IV. Provider business mailing address

2251 N SHORE DR
RHINELANDER WI
54501-6710
US

V. Phone/Fax

Practice location:
  • Phone: 715-361-2000
  • Fax:
Mailing address:
  • Phone: 715-361-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005961
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: