Provider Demographics
NPI:1063593309
Name:HAMILTON, ALICE DARLENE (PNP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:DARLENE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:DARLENE
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-0568
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-352-8658
Practice Address - Street 1:22300 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7373
Practice Address - Country:US
Practice Address - Phone:503-431-5975
Practice Address - Fax:503-431-5976
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 000041071N2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics