MEDICARE: JADA HAMMER

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	172V00000X	Community Health Worker
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1831787092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA HAMMER

Provider Business Mailing Address
First Line	:	7341 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1573
Country	:	US
Telephone Number	:	712-281-4165
Fax Number	:

Provider Business Practice Location Address
First Line	:	7341 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1573
Country	:	US
Telephone Number	:	712-281-4165
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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Directions to “ JADA HAMMER ” Practice Location

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