Provider Demographics
NPI:1124800362
Name:HAMILTON, DYLAN JAMES MICHAEL (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES MICHAEL
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 ARBORETUM DR APT 104
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2794
Mailing Address - Country:US
Mailing Address - Phone:920-450-6415
Mailing Address - Fax:
Practice Address - Street 1:1545 ARBORETUM DR APT 104
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2794
Practice Address - Country:US
Practice Address - Phone:920-450-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242220163W00000X
WI242220-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse