1558666925 NPI number — SHANE E HAMMAN P.T.

Table of content: SHANE E HAMMAN P.T. (NPI 1558666925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558666925 NPI number — SHANE E HAMMAN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMAN
Provider First Name:
SHANE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558666925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1667 LUCERNE ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
MINDEN
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89423-4360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-381-8947
Provider Business Mailing Address Fax Number:
808-396-6358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 WARD AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-381-8947
Provider Business Practice Location Address Fax Number:
808-396-6358
Provider Enumeration Date:
01/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-3309 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99-0353213 . This is a "UHA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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