Healthcare Provider Details

I. General information

NPI: 1811021165
Provider Name (Legal Business Name): CARMELLIA MARIE HAMILTON RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W. RENO
OKLAHOMA CITY OK
73127
US

IV. Provider business mailing address

8404 CANYON TRAIL DRIVE
OKLAHOMA CITY OK
73135
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4919
Mailing address:
  • Phone: 405-200-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR0069271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: