MEDICARE: MRS. DENISE L HAMILTON

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	376K00000X	Nurse's Aide		AL

General Provider Information

NPI Number	:	1710591912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE L HAMILTON

Provider Business Mailing Address
First Line	:	3031 N COLONIAL DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 N COLONIAL DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2905
Country	:	US
Telephone Number	:	334-549-6686
Fax Number	:

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

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/09/2020

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