Individual
SANDRA K HAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
107 W HESSE, BUFFALO, WY 82834
(307) 684-1444
(307) 684-0999
Mailing address
107 W. HESSE, BUFFALO, WY 82834
(307) 684-1444
(307) 684-0999
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
23899
WY
363LF0000X
Family Nurse Practitioner
Primary
23899-0963
WY
363LF0000X
Family Nurse Practitioner
CP000529
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126725600
—
WY
01
—
53D2028400
CLIA
WY
01
—
S102619
MEDICARE PTAN
WY
Enumeration date
05/15/2008
Last updated
11/01/2011
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