Provider Demographics
NPI:1609314269
Name:HAMMOND, NATALIE MARIE (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-5618 MAIAU ST STE A204
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2634
Mailing Address - Country:US
Mailing Address - Phone:952-239-0770
Mailing Address - Fax:
Practice Address - Street 1:73-5618 MAIAU ST STE A204
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2634
Practice Address - Country:US
Practice Address - Phone:952-239-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08653363AM0700X
MN12321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical