Provider Demographics
NPI:1013544667
Name:HAMILTON, ANNIE PENQUITE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:PENQUITE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:LORRAINE
Other - Last Name:PENQUITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-2400
Mailing Address - Fax:515-643-4766
Practice Address - Street 1:5900 E UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8467
Practice Address - Country:US
Practice Address - Phone:515-643-2400
Practice Address - Fax:515-643-4766
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA101949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program