Provider Demographics
NPI:1588284889
Name:HAMMER, ALEXIS MARIE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:HAMMER
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARMONY HL
Mailing Address - Street 2:
Mailing Address - City:CRESSONA
Mailing Address - State:PA
Mailing Address - Zip Code:17929-1004
Mailing Address - Country:US
Mailing Address - Phone:570-573-7404
Mailing Address - Fax:
Practice Address - Street 1:5 HARMONY HL
Practice Address - Street 2:
Practice Address - City:CRESSONA
Practice Address - State:PA
Practice Address - Zip Code:17929-1004
Practice Address - Country:US
Practice Address - Phone:570-573-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006914133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered