Healthcare Provider Details

I. General information

NPI: 1467606277
Provider Name (Legal Business Name): BRIAN J HAMILTON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6903 S310E AVE
BROKEN ARROW OH
74014
US

IV. Provider business mailing address

6903 S310TH E AVE
BROKEN ARROW OK
74014
US

V. Phone/Fax

Practice location:
  • Phone: 918-691-4059
  • Fax:
Mailing address:
  • Phone: 918-691-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0066384
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: