Basic Information
| Provider Information | |||||||||
| NPI: | 1841211042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMERSTEIN | ||||||||
| FirstName: | JEANETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 4301080228 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 1841211042 | 01 | UNSPECIFIED | OTHER |