Provider Demographics
NPI:1457135014
Name:HAMM, BOBBY JO (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JO
Last Name:HAMM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SD HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2526
Mailing Address - Country:US
Mailing Address - Phone:605-698-4363
Mailing Address - Fax:605-698-4367
Practice Address - Street 1:1820 SD HIGHWAY 10 STE C
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2527
Practice Address - Country:US
Practice Address - Phone:605-698-4363
Practice Address - Fax:605-698-4367
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X, 376J00000X, 251X00000X
SDRO32738163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No251X00000XAgenciesSupports Brokerage