Provider Demographics
NPI:1306391701
Name:HAMMAN, VIRGINIA DELORES (LSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DELORES
Last Name:HAMMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 E FRANKLIN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2101
Mailing Address - Country:US
Mailing Address - Phone:612-343-4004
Mailing Address - Fax:
Practice Address - Street 1:1433 E FRANKLIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2101
Practice Address - Country:US
Practice Address - Phone:612-343-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20736251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health