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General NPI Number Information
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NPI Number | 1104978873
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Entity Type | Individual
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Provider Name | CARLIE JO HAMILTON FNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 12272 S 800 E SUITE A
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City | DRAPER
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State | UT
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Zip | 84020-9789
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Country | US
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Telephone | 801-523-1300
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Fax | 801-523-1301
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Provider Business Mailing Address
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Address Line | 12272 S 800 E SUITE A
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City | DRAPER
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State | UT
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Zip | 84020-9789
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Country | US
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Telephone | 801-523-1300
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Fax | 801-523-1301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 294110-4405
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License Number State | UT
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