Provider Demographics
NPI:1306166772
Name:HAMM, MARY (ARNP/CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:ARNP/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 RED BANK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2172
Mailing Address - Country:US
Mailing Address - Phone:513-321-4333
Mailing Address - Fax:513-232-0100
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-321-4333
Practice Address - Fax:513-232-0100
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09858-NP363L00000X
KY3005423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner