Provider Demographics
NPI:1598067779
Name:HAMMEL, MARY M (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HAMMEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 SMIZER MILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3483
Mailing Address - Country:US
Mailing Address - Phone:636-717-1350
Mailing Address - Fax:636-717-1355
Practice Address - Street 1:1203 SMIZER MILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3483
Practice Address - Country:US
Practice Address - Phone:636-717-1350
Practice Address - Fax:636-717-1355
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010035829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01276098OtherRAILROAD MEDICARE
MO1598067779Medicaid
MOP01276098OtherRAILROAD MEDICARE
MO1598067779Medicaid