Provider Demographics
NPI:1700870680
Name:HAMNER, LYNDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:SUE
Last Name:HAMNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:551 KOKOPELLI BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-6305
Mailing Address - Country:US
Mailing Address - Phone:970-241-1503
Mailing Address - Fax:970-858-2555
Practice Address - Street 1:551 KOKOPELLI BLVD
Practice Address - Street 2:STE J
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6305
Practice Address - Country:US
Practice Address - Phone:970-214-1503
Practice Address - Fax:970-858-2555
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80500536Medicaid
COC553278Medicare PIN
CO80500536Medicaid