Provider Demographics
NPI:1376291708
Name:HAMMOND, ALEXIS JADE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JADE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WYANDOTTE RD
Mailing Address - Street 2:
Mailing Address - City:HOYT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55750
Mailing Address - Country:US
Mailing Address - Phone:218-994-1802
Mailing Address - Fax:
Practice Address - Street 1:112 WYANDOTTE RD
Practice Address - Street 2:
Practice Address - City:HOYT LAKES
Practice Address - State:MN
Practice Address - Zip Code:55750-1224
Practice Address - Country:US
Practice Address - Phone:218-994-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide