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General NPI Number Information
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NPI Number | 1528596558
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Entity Type | Individual
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Provider Name | CHERESSA RAQUEL HAMM PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1235 INDUSTRIAL DR STE 1
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City | SALINE
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State | MI
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Zip | 48176-1742
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Country | US
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Telephone | 734-944-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 SYCKELMOORE ST
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City | TRENTON
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State | MI
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Zip | 48183-3570
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Country | US
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Telephone | 419-966-7891
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601008264
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License Number State | MI
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