Provider Demographics
NPI:1275991606
Name:HAMILTON, NICOLE ALYSSA (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSSA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22285 N PEPPER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2540
Mailing Address - Country:US
Mailing Address - Phone:847-382-8050
Mailing Address - Fax:847-382-0923
Practice Address - Street 1:22285 N PEPPER RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2540
Practice Address - Country:US
Practice Address - Phone:847-382-5080
Practice Address - Fax:847-382-0923
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013820208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology