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General NPI Number Information
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NPI Number | 1275024341
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Entity Type | Individual
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Provider Name | ETHAN HAMILTON CNP
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Gender | Male
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 621 W LAKE ST STE 350
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2952
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Country | US
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Telephone | 612-979-2276
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Fax |
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Provider Business Mailing Address
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Address Line | 428 MINNESOTA ST UNIT 500
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City | SAINT PAUL
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State | MN
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Zip | 55101-2666
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 6446
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1640188
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2470803
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License Number State | MN
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