Provider Demographics
NPI:1386943967
Name:HAMER, NICOLE LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE
Last Name:HAMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2026
Mailing Address - Country:US
Mailing Address - Phone:260-246-3489
Mailing Address - Fax:
Practice Address - Street 1:1003 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2026
Practice Address - Country:US
Practice Address - Phone:260-246-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27051635A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse