MEDICARE: ISABEL SUSAN MARIE HAMMOND

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699590844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL SUSAN MARIE HAMMOND

Provider Business Mailing Address
First Line	:	330 SILVER CREEK RD
Second Line	:
City	:	WHITEHALL
State	:	MI
Zip	:	49461-9547
Country	:	US
Telephone Number	:	231-855-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 SILVER CREEK RD
Second Line	:
City	:	WHITEHALL
State	:	MI
Zip	:	49461-9547
Country	:	US
Telephone Number	:	231-855-2120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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