Provider Demographics
NPI:1164297156
Name:HAMILTON, MARANDA LYNN (APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 175TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-3582
Mailing Address - Country:US
Mailing Address - Phone:402-955-5437
Mailing Address - Fax:402-955-7310
Practice Address - Street 1:110 N 175TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3582
Practice Address - Country:US
Practice Address - Phone:402-955-5437
Practice Address - Fax:402-955-7310
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115105363LP2300X
IAC175679363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics