Provider Demographics
NPI:1083687941
Name:HAMILTON, ABBY L (PA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88541
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53288-0001
Mailing Address - Country:US
Mailing Address - Phone:866-234-4181
Mailing Address - Fax:
Practice Address - Street 1:2601 W. BELTLINE HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:608-260-2100
Practice Address - Fax:608-260-2101
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1835-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42874300Medicaid
WI54455Medicare ID - Type Unspecified
WI14020Medicare ID - Type Unspecified
WI42874300Medicaid
WIQ52160Medicare UPIN
WI15040Medicare ID - Type Unspecified