MEDICARE: MS. KATRINA CELESTE HAMEL PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1194075002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATRINA CELESTE HAMEL PA-C

Provider Business Mailing Address
First Line	:	9045 US HIGHWAY 31
Second Line	:	SUITE A
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1804
Country	:	US
Telephone Number	:	269-473-2222
Fax Number	:	269-473-6880

Provider Business Practice Location Address
First Line	:	9045 US HIGHWAY 31
Second Line	:	SUITE A
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1804
Country	:	US
Telephone Number	:	269-473-2222
Fax Number	:	269-473-6880

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	02/17/2016

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