Provider Demographics
NPI:1427820596
Name:HAMM, ALEXANDRA (RN)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 JOEL LN
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-7531
Mailing Address - Country:US
Mailing Address - Phone:815-762-6685
Mailing Address - Fax:
Practice Address - Street 1:1005 JOEL LN
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-7531
Practice Address - Country:US
Practice Address - Phone:815-899-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0414374582080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology