Provider Demographics
NPI:1073509477
Name:HAMM-JOHNSON, TERRI (RNC MS)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HAMM-JOHNSON
Suffix:
Gender:F
Credentials:RNC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3129
Mailing Address - Country:US
Mailing Address - Phone:719-471-3471
Mailing Address - Fax:719-471-0744
Practice Address - Street 1:140 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3129
Practice Address - Country:US
Practice Address - Phone:719-471-3471
Practice Address - Fax:719-471-0744
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75137363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC442168Medicare PIN
COP38798Medicare UPIN