Provider Demographics
NPI:1528596558
Name:HAMM, CHERESSA RAQUEL (PA-C)
Entity type:Individual
Prefix:
First Name:CHERESSA
Middle Name:RAQUEL
Last Name:HAMM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 SYCKELMOORE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3570
Mailing Address - Country:US
Mailing Address - Phone:419-966-7891
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1742
Practice Address - Country:US
Practice Address - Phone:734-944-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008264363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical