Provider Demographics
NPI:1134316813
Name:HAMILTON, DOROTHEA RENA (CSA)
Entity Type:Individual
Prefix:MS
First Name:DOROTHEA
Middle Name:RENA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 WHITEWATER TRL
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5443
Mailing Address - Country:US
Mailing Address - Phone:972-345-5074
Mailing Address - Fax:
Practice Address - Street 1:924 WHITEWATER TRL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5443
Practice Address - Country:US
Practice Address - Phone:972-345-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3354246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant