Provider Demographics
NPI:1932635687
Name:HAMILTON, JORDAN LILY ROWENA (RN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LILY ROWENA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 O ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6429
Mailing Address - Country:US
Mailing Address - Phone:916-397-7701
Mailing Address - Fax:
Practice Address - Street 1:1590 DREW AVE STE 210
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7848
Practice Address - Country:US
Practice Address - Phone:530-297-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407433RN163W00000X, 163WP0808X
CA95193592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health