Provider Demographics
NPI:1447580030
Name:HUMMEL, ANNA BERNADINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:BERNADINE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:BERNADINE
Other - Last Name:RADEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1241 W. STADIUM BLVD.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6023
Mailing Address - Country:US
Mailing Address - Phone:573-634-4878
Mailing Address - Fax:573-634-7423
Practice Address - Street 1:1241 W. STADIUM BLVD.
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-634-4878
Practice Address - Fax:573-634-7423
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01135354OtherRAILROAD MEDICARE
MOP01135354OtherRAILROAD MEDICARE
MO152810046Medicare PIN