Provider Demographics
NPI:1033864004
Name:LEWIS HAMILTON, BRENDA L (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:LEWIS 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:W12432 HWY 16 60
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-2009
Mailing Address - Country:US
Mailing Address - Phone:920-319-6399
Mailing Address - Fax:
Practice Address - Street 1:W12432 HWY 16 60
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-2009
Practice Address - Country:US
Practice Address - Phone:920-319-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327065-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse