Provider Demographics
NPI:1083501340
Name:HAMILTON, MICHAELLE ROSEANNA
Entity type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:ROSEANNA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9698 E HIGHWAY 88 LOT 10
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-9413
Mailing Address - Country:US
Mailing Address - Phone:615-289-7282
Mailing Address - Fax:
Practice Address - Street 1:9698 E HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-9464
Practice Address - Country:US
Practice Address - Phone:615-289-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist