Provider Demographics
NPI:1427669332
Name:HAMMAN, ODESSA FAY (LPN)
Entity type:Individual
Prefix:
First Name:ODESSA
Middle Name:FAY
Last Name:HAMMAN
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 1:737 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4048
Mailing Address - Country:US
Mailing Address - Phone:419-230-7352
Mailing Address - Fax:
Practice Address - Street 1:737 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4048
Practice Address - Country:US
Practice Address - Phone:419-230-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse