Provider Demographics
NPI:1023767167
Name:HAMMOND, MATTIE CARMEN
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:CARMEN
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT. 52 PIONEER DR. BOX 427
Mailing Address - Street 2:
Mailing Address - City:VARNEY
Mailing Address - State:WV
Mailing Address - Zip Code:25696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RT. 52 PIONEER DR.
Practice Address - Street 2:
Practice Address - City:VARNEY
Practice Address - State:WV
Practice Address - Zip Code:25696
Practice Address - Country:US
Practice Address - Phone:304-426-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant