Provider Demographics
NPI:1467916213
Name:HAMMON, REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HAMMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:ID
Mailing Address - Zip Code:83655-5109
Mailing Address - Country:US
Mailing Address - Phone:208-989-3896
Mailing Address - Fax:
Practice Address - Street 1:1441 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-5420
Practice Address - Country:US
Practice Address - Phone:208-642-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily