Provider Demographics
NPI:1215434683
Name:HAMOR, TRACEY LYNN
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:HAMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N. 4TH STREET
Mailing Address - Street 2:PO BOX 208
Mailing Address - City:ELMWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68349-6027
Mailing Address - Country:US
Mailing Address - Phone:402-840-9896
Mailing Address - Fax:470-275-0883
Practice Address - Street 1:140 N 4TH ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:NE
Practice Address - Zip Code:68349-2269
Practice Address - Country:US
Practice Address - Phone:402-840-9896
Practice Address - Fax:470-275-0883
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112459363LF0000X, 363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program