Provider Demographics
NPI:1366482515
Name:HAMLIN, SUSAN L (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1475 KISKER ROAD
Practice Address - Street 2:SUITE 180
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8786
Practice Address - Country:US
Practice Address - Phone:636-442-7300
Practice Address - Fax:636-442-7398
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONP147806363L00000X
MO147806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MORN147806OtherREGISTERED NURSE LISC.
MONP147806OtherNURSE PRACTIONER LISC.