Healthcare Provider Details

I. General information

NPI: 1184366312
Provider Name (Legal Business Name): CLAIRE HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date: 06/15/2023
Reactivation Date: 06/29/2023

III. Provider practice location address

100 ANGUS E PEYTON DR
SOUTH CHARLESTON WV
25303-1600
US

IV. Provider business mailing address

2611 MERRYWOOD RD
CHARLOTTE NC
28210-6715
US

V. Phone/Fax

Practice location:
  • Phone: 304-746-2500
  • Fax:
Mailing address:
  • Phone: 304-553-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number143304
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: