Provider Demographics
NPI:1730800434
Name:HAMM, SHEA QUESENBERRY
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:QUESENBERRY
Last Name:HAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 INDIAN VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:VA
Mailing Address - Zip Code:24380-4185
Mailing Address - Country:US
Mailing Address - Phone:540-239-4724
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7494
Practice Address - Country:US
Practice Address - Phone:540-776-4274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001219427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse