Provider Demographics
NPI:1356972897
Name:HAMMES, NICOLE (RDA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HAMMES
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8976
Mailing Address - Country:US
Mailing Address - Phone:559-900-7133
Mailing Address - Fax:559-854-1013
Practice Address - Street 1:2497 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8976
Practice Address - Country:US
Practice Address - Phone:559-900-7133
Practice Address - Fax:559-854-1013
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA69709126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant