Provider Demographics
NPI:1366838765
Name:HAMILTON, CONTESSA (LPN)
Entity Type:Individual
Prefix:MS
First Name:CONTESSA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26767 LAKEVUE DR
Mailing Address - Street 2:APT 7
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3358
Mailing Address - Country:US
Mailing Address - Phone:419-984-5884
Mailing Address - Fax:
Practice Address - Street 1:26767 LAKEVUE DR
Practice Address - Street 2:APT 7
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3358
Practice Address - Country:US
Practice Address - Phone:419-984-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703113327164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse