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NPI Code Detail

MEDICARE: MRS. JESSICA LYNN HAMILTON CNM

MEDICARE: MRS. JESSICA LYNN HAMILTON CNM
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
1367A00000XAdvanced Practice Midwife14474WI
2367A00000XAdvanced Practice MidwifeB131985IA
3367A00000XAdvanced Practice Midwife6287WI
4367A00000XAdvanced Practice Midwife148903WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AC000493OTHERMDACNM CERTIFICATE NUMBER

General Provider Information

NPI Number : 1427242296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA LYNN HAMILTON CNM
Provider Business Mailing Address
First Line : 1836 SOUTH AVE.
Second Line :
City : LA CROSSE
State : WI
Zip : 54601
Country : US
Telephone Number : 608-782-7300
Fax Number :
Provider Business Practice Location Address
First Line : 1836 SOUTH AVE
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5429
Country : US
Telephone Number : 608-782-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 07/15/2015

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