Provider Demographics
NPI:1194880955
Name:HAMMER, DEBRA HARRIS (CNM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:HARRIS
Last Name:HAMMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:257 W SAINT GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840-7827
Mailing Address - Country:US
Mailing Address - Phone:715-463-5317
Mailing Address - Fax:715-463-2753
Practice Address - Street 1:257 W SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840-7827
Practice Address - Country:US
Practice Address - Phone:715-463-5317
Practice Address - Fax:715-463-2753
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148794367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41277300Medicaid
WI001109035Medicare PIN
WI41277300Medicaid