Healthcare Provider Details

I. General information

NPI: 1932635687
Provider Name (Legal Business Name): JORDAN LILY ROWENA HAMILTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZUZU HAMILTON RN

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 HALYARD DR STE 11A
WEST SACRAMENTO CA
95691-5037
US

IV. Provider business mailing address

2715 O ST APT 5
SACRAMENTO CA
95816-6429
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-4489
  • Fax:
Mailing address:
  • Phone: 916-397-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95193592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201407433RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201407433RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: