Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71008100A | IN |
NPI | 1093200339 |
---|---|
Provider Name | Mrs. Tracy Renee Hammond |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Greenwood, IN 46143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 10/09/2020 |