MEDICARE: MS. DEVRA ANN HAMILTON NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	TAPN700568	NV

General Provider Information

NPI Number	:	1225354616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEVRA ANN HAMILTON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	15 STUNNING SUMMIT AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-3331
Country	:	US
Telephone Number	:	702-522-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 MCDANIEL ST STE 105
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7170
Country	:	US
Telephone Number	:	702-657-3773
Fax Number	:	702-657-3760

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

Provider Enumeration Date	:	04/11/2010
Last Update Date	:	04/11/2010

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