Provider Demographics
NPI:1104550268
Name:HAMAKER, AUGUSTA R (PA-C)
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:R
Last Name:HAMAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20794 212TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-7202
Mailing Address - Country:US
Mailing Address - Phone:641-208-6141
Mailing Address - Fax:
Practice Address - Street 1:304 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565-1164
Practice Address - Country:US
Practice Address - Phone:319-293-3171
Practice Address - Fax:319-774-0382
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA124425363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program