Provider Demographics
NPI:1720535834
Name:HAM, EMMILY (MS, CRNA)
Entity Type:Individual
Prefix:
First Name:EMMILY
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:MS, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 E TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9770
Mailing Address - Country:US
Mailing Address - Phone:989-737-0694
Mailing Address - Fax:
Practice Address - Street 1:11990 E TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-9770
Practice Address - Country:US
Practice Address - Phone:989-737-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered