Provider Demographics
NPI:1043508518
Name:HAMM, MARIBEL R (CNM)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:R
Last Name:HAMM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:R
Other - Last Name:KISSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5225 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7927
Mailing Address - Country:US
Mailing Address - Phone:701-417-2575
Mailing Address - Fax:
Practice Address - Street 1:5225 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7927
Practice Address - Country:US
Practice Address - Phone:701-417-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72174163WW0101X
NDR42848367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory