Provider Demographics
NPI:1164769758
Name:HAMELIN, MARY CATHERINE (LM)
Entity Type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:
Last Name:HAMELIN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 W EMPEDRADO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6831
Mailing Address - Country:US
Mailing Address - Phone:813-765-4414
Mailing Address - Fax:
Practice Address - Street 1:3810 W EMPEDRADO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6831
Practice Address - Country:US
Practice Address - Phone:813-765-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 374J00000X
FL367176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula