Provider Demographics
NPI:1699704072
Name:HAMM, NATHAN (FNP, DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:HAMM
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1149
Mailing Address - Country:US
Mailing Address - Phone:315-400-3031
Mailing Address - Fax:315-400-3114
Practice Address - Street 1:109 PINE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1149
Practice Address - Country:US
Practice Address - Phone:315-400-3031
Practice Address - Fax:315-400-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011001111N00000X
NYF339967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV04058Medicare UPIN
NYRA5892Medicare ID - Type Unspecified