Provider Demographics
NPI:1457359911
Name:HAMAN, D'ETTA ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:D'ETTA
Middle Name:ELAINE
Last Name:HAMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 MILLS RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-9305
Mailing Address - Country:US
Mailing Address - Phone:419-343-1510
Mailing Address - Fax:
Practice Address - Street 1:2950 MILLS RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-9305
Practice Address - Country:US
Practice Address - Phone:419-343-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH76071Medicare ID - Type UnspecifiedMEDICARE
OH16952Medicare UPIN