Provider Demographics
NPI:1265819916
Name:HAMMIE, ETTA LEORA (LVN)
Entity Type:Individual
Prefix:MISS
First Name:ETTA
Middle Name:LEORA
Last Name:HAMMIE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SKYLINE DR
Mailing Address - Street 2:APT 1412
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-1383
Mailing Address - Country:US
Mailing Address - Phone:817-298-9792
Mailing Address - Fax:817-617-3479
Practice Address - Street 1:2327 OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:817-984-1496
Practice Address - Fax:817-984-1497
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171393164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse