Provider Demographics
NPI: | 1164848636 |
---|---|
Name: | HAMILTON, MARNELLI JOANNE (NP, RN) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARNELLI |
Middle Name: | JOANNE |
Last Name: | HAMILTON |
Suffix: | |
Gender: | F |
Credentials: | NP, RN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5608 ZUNI RD SE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87108-2926 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5608 ZUNI RD SE |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87108 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-262-2481 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-03-08 |
Last Update Date: | 2019-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | RN-84068 | 163W00000X |
NY | 673201 | 163W00000X |
NY | 307181 | 363LA2200X |
NM | CNP-02937 | 363LP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |