Provider Demographics
NPI:1245977461
Name:HAMMERSTAD, JASMINE RACHELLE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RACHELLE
Last Name:HAMMERSTAD
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 1:1881 OAK AVE # APTPH02W
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3980
Mailing Address - Country:US
Mailing Address - Phone:541-231-9307
Mailing Address - Fax:
Practice Address - Street 1:1881 OAK AVE # APTPH02W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3980
Practice Address - Country:US
Practice Address - Phone:541-231-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant