Provider Demographics
NPI:1558317560
Name:HUMMEL, MARY ELAINE (MSN, APRN-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MSN, APRN-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5607
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:134 ANSLEY DR STE 700
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1641
Practice Address - Country:US
Practice Address - Phone:706-864-2155
Practice Address - Fax:706-374-7628
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN053488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA539432806CMedicaid