Healthcare Provider Details

I. General information

NPI: 1780638387
Provider Name (Legal Business Name): MADELYN HAMILTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N MAIN ST STE 4002 GRANITE CITY PRIMARY CARE
BARRE VT
05641-4513
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-479-2546
  • Fax: 802-479-1346
Mailing address:
  • Phone: 802-479-2546
  • Fax: 802-479-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0017211
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1010017211
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: