Provider Demographics
NPI:1215915061
Name:HAMILTON, SELMA L (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:SELMA
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PECK ROAD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-489-6899
Mailing Address - Fax:860-496-9844
Practice Address - Street 1:52 PECK ROAD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-489-6899
Practice Address - Fax:860-496-9844
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q49014Medicare UPIN
MANP5092Medicare PIN
MA0703486Medicaid
VT1012228Medicaid