Provider Demographics
NPI:1003275637
Name:HAMMER, STACY JOY (RDN,LD)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JOY
Last Name:HAMMER
Suffix:
Gender:F
Credentials:RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39648 RES HWY 3
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MN
Mailing Address - Zip Code:56270
Mailing Address - Country:US
Mailing Address - Phone:507-697-8600
Mailing Address - Fax:507-697-8911
Practice Address - Street 1:39648 RES HWY 3
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MN
Practice Address - Zip Code:56270
Practice Address - Country:US
Practice Address - Phone:507-697-8600
Practice Address - Fax:507-697-8911
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered