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General NPI Number Information
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NPI Number | 1417446832
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Entity Type | Individual
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Provider Name | MICHAEL SHANE HAMMETT CRNP
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Gender | Male
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 4258 US HIGHWAY 80 W
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City | SELMA
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State | AL
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Zip | 36701-2202
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Country | US
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Telephone | 334-874-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 249 MACALLAN DR
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City | PELHAM
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State | AL
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Zip | 35124-6245
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Country | US
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Telephone | 205-238-8643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-129043
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License Number State | AL
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