Healthcare Provider Details

I. General information

NPI: 1215554431
Provider Name (Legal Business Name): RACHEL MARIE HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26640 S JACOB DR
CHANNAHON IL
60410-5475
US

IV. Provider business mailing address

26640 S JACOB DR
CHANNAHON IL
60410-5475
US

V. Phone/Fax

Practice location:
  • Phone: 815-474-8378
  • Fax:
Mailing address:
  • Phone: 815-474-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110007537
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: