MEDICARE: MRS. BRENDA A HAMILTON PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	425599	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174515936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA A HAMILTON PNP

Provider Business Mailing Address
First Line	:	947 OAK FOREST DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1227
Country	:	US
Telephone Number	:	214-376-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SPRING AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1350
Country	:	US
Telephone Number	:	214-670-7664
Fax Number	:	214-670-8036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/09/2007

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