Provider Demographics
NPI:1215110598
Name:HAMILTON, DANA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HIGHWAY 9 N
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:MS
Mailing Address - Zip Code:38951-9759
Mailing Address - Country:US
Mailing Address - Phone:662-412-2285
Mailing Address - Fax:662-412-2285
Practice Address - Street 1:183 HIGHWAY 9 N
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:MS
Practice Address - Zip Code:38951-9759
Practice Address - Country:US
Practice Address - Phone:662-412-2285
Practice Address - Fax:662-412-2285
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP291178164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770218Medicaid