Provider Demographics
NPI:1770833238
Name:HAMM, MELINDA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:DAWN
Last Name:HAMM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:DAWN
Other - Last Name:SAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1508 3RD AVE EAST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219
Mailing Address - Country:US
Mailing Address - Phone:276-523-0599
Mailing Address - Fax:276-523-4690
Practice Address - Street 1:1508 3RD AVE EAST
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219
Practice Address - Country:US
Practice Address - Phone:276-523-0599
Practice Address - Fax:276-523-4690
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002059154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002059154OtherLPN