Provider Demographics
NPI:1366037277
Name:RAELYN HAMMAN, NP-C LLC
Entity Type:Organization
Organization Name:RAELYN HAMMAN, NP-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:408-202-4130
Mailing Address - Street 1:8035 SANTA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4941
Mailing Address - Country:US
Mailing Address - Phone:408-202-4130
Mailing Address - Fax:
Practice Address - Street 1:612 MEIGS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1517
Practice Address - Country:US
Practice Address - Phone:408-202-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty