Provider Demographics
NPI:1528297389
Name:HUMMEL, JOAN M (PA-C)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-546-5671
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1835
Practice Address - Country:US
Practice Address - Phone:937-667-1122
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005554363A00000X
OH50003084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA84971 - LIMAMedicare PIN
OHPA84972 - NEW CARLISMedicare PIN