Provider Demographics
NPI:1104168921
Name:HAMPTON, CARLY ELISE (BSN,RN,MSN, CNM)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ELISE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:BSN,RN,MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E BRINGHURST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1719
Mailing Address - Country:US
Mailing Address - Phone:215-844-1020
Mailing Address - Fax:215-844-2702
Practice Address - Street 1:251 E BRINGHURST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1719
Practice Address - Country:US
Practice Address - Phone:215-844-1020
Practice Address - Fax:215-844-1020
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN575828163W00000X
PAMW010303367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse