Provider Demographics
NPI:1073668612
Name:HAMM, MARIANNE (NP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 E BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3202
Mailing Address - Country:US
Mailing Address - Phone:559-435-8029
Mailing Address - Fax:559-278-7602
Practice Address - Street 1:5044 N BARTON AVEN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-2734
Practice Address - Fax:559-278-7602
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1661OtherNP FURNISHING NUMBER
CA277539OtherRN LICENSE NUMBER