Provider Demographics
NPI:1922208669
Name:HAMMOND, LINDA MARY (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARY
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-2425
Mailing Address - Country:US
Mailing Address - Phone:315-882-1762
Mailing Address - Fax:
Practice Address - Street 1:109 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2217
Practice Address - Country:US
Practice Address - Phone:315-487-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443122-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411067Medicaid