Provider Demographics
NPI:1205043916
Name:HAMAKER, MARIE ADALINE (B S, L P N)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ADALINE
Last Name:HAMAKER
Suffix:
Gender:F
Credentials:B S, L P N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1152
Mailing Address - Country:US
Mailing Address - Phone:814-371-1100
Mailing Address - Fax:
Practice Address - Street 1:100 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1152
Practice Address - Country:US
Practice Address - Phone:814-371-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPN048936L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse