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General NPI Number Information
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NPI Number | 1972309995
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Entity Type | Individual
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Provider Name | BIANCA LEIGH HAMILTON 3B6878AE-B8D7-44F5-B
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 08/09/2026
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Provider Practice Location Address
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Address Line | 163 W HIGH ST
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City | JACKSON
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State | MI
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Zip | 49203
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Country | US
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Telephone | 517-240-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 163 W HIGH ST
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City | JACKSON
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State | MI
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Zip | 49203-3173
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Country | US
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Telephone | 517-307-6848
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | 3936356
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number | 393657
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License Number State | MI
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