Provider Demographics
NPI:1114196748
Name:HAMILTON, EUNICE (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 STATELINE RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4729
Mailing Address - Country:US
Mailing Address - Phone:269-684-2810
Mailing Address - Fax:248-218-9996
Practice Address - Street 1:1211 STATELINE RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4729
Practice Address - Country:US
Practice Address - Phone:269-684-2810
Practice Address - Fax:248-218-9996
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0877675OtherBCBSM
MIMI2051010Medicare PIN