Provider Demographics
NPI:1225354616
Name:HAMILTON, DEVRA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DEVRA
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:15 STUNNING SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3331
Mailing Address - Country:US
Mailing Address - Phone:702-522-0564
Mailing Address - Fax:
Practice Address - Street 1:1905 MCDANIEL ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7170
Practice Address - Country:US
Practice Address - Phone:702-657-3773
Practice Address - Fax:702-657-3760
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTAPN700568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily