Healthcare Provider Details

I. General information

NPI: 1033215850
Provider Name (Legal Business Name): PHYLLIS ANN HAMMER C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E PEARL ST
HARRISVILLE WV
26362-9759
US

IV. Provider business mailing address

686 S PIKE ST STE A
SHINNSTON WV
26431-1043
US

V. Phone/Fax

Practice location:
  • Phone: 304-643-2957
  • Fax: 304-643-2958
Mailing address:
  • Phone: 304-624-4655
  • Fax: 304-624-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37013
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: