Provider Demographics
NPI:1871127019
Name:HAMM, MICAH (FNP)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W WEAVER RD STE 145D
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9768
Mailing Address - Country:US
Mailing Address - Phone:217-876-5200
Mailing Address - Fax:217-876-5206
Practice Address - Street 1:4775 E MARYLAND ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-8820
Practice Address - Country:US
Practice Address - Phone:217-864-3737
Practice Address - Fax:217-864-3468
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020719363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care