Provider Demographics
NPI:1073321683
Name:HAMMEL, TRACEY KAREN (RN CWOCN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:KAREN
Last Name:HAMMEL
Suffix:
Gender:F
Credentials:RN CWOCN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:KAREN
Other - Last Name:PADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4216 JUNIPER PT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1891
Mailing Address - Country:US
Mailing Address - Phone:651-253-8346
Mailing Address - Fax:
Practice Address - Street 1:4216 JUNIPER PT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1891
Practice Address - Country:US
Practice Address - Phone:651-253-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR135782-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse