Healthcare Provider Details

I. General information

NPI: 1588010771
Provider Name (Legal Business Name): KATIE JANE HAMILTON CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 01/25/2020
Certification Date: 01/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 HARRIMAN LN
REDONDO BEACH CA
90278-4532
US

IV. Provider business mailing address

2604 HARRIMAN LN
REDONDO BEACH CA
90278-4532
US

V. Phone/Fax

Practice location:
  • Phone: 310-944-0622
  • Fax:
Mailing address:
  • Phone: 310-944-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM582
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-45264
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: