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NPI Code Detail

MEDICARE: MS. KIMBERLY J HAMMON MS RD LDN

MEDICARE: MS. KIMBERLY J HAMMON MS RD LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WD0400XDiabetes Educator Registered Nurse164000434IL
2133V00000XRegistered Dietitian164000434IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1164000434OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1104083799
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY J HAMMON MS RD LDN
Provider Business Mailing Address
First Line : 1410 N ARLINGTON HEIGHTS RD STE 200
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-4827
Country : US
Telephone Number : 847-618-1640
Fax Number : 847-618-1649
Provider Business Practice Location Address
First Line : 1410 N ARLINGTON HEIGHTS RD STE 200
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-4827
Country : US
Telephone Number : 847-618-1640
Fax Number : 847-618-1649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2008
Last Update Date : 07/21/2022

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