MEDICARE: MS. MARY B 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	60824	CO

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	:	1346318714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY B HAMILTON PNP

Provider Business Mailing Address
First Line	:	1065 NE 125TH ST
Second Line	:	SUITE 409
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5821
Country	:	US
Telephone Number	:	888-852-6672
Fax Number	:	305-503-7363

Provider Business Practice Location Address
First Line	:	8671 S QUEBEC ST
Second Line	:	STE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-5859
Country	:	US
Telephone Number	:	303-683-5620
Fax Number	:	303-683-5609

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/17/2015

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