Healthcare Provider Details

I. General information

NPI: 1154441020
Provider Name (Legal Business Name): MAUREEN V DAVE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN HAMILTON PA-C

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/08/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 LOUIS HENNA BLVD
AUSTIN TX
78749-7874
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 512-988-5355
  • Fax: 512-323-0307
Mailing address:
  • Phone: 512-988-5355
  • Fax: 512-323-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA04682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: