MEDICARE: MS. MAUREEN PHYLLIS HAMILTON LPN

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	3747P1801X	Personal Care Attendant	109844500	FL

General Provider Information

NPI Number	:	1912675562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN PHYLLIS HAMILTON LPN

Provider Business Mailing Address
First Line	:	6 ARCHANGEL CIR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-9412
Country	:	US
Telephone Number	:	352-514-4970
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 ARCHANGEL CIR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-9412
Country	:	US
Telephone Number	:	352-514-4970
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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