Provider Demographics
NPI:1386648897
Name:HAMILTON, JONNIE M (PNP)
Entity Type:Individual
Prefix:MS
First Name:JONNIE
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Mailing Address - Street 1:18250 MARK TWAIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2546
Mailing Address - Country:US
Mailing Address - Phone:313-866-9973
Mailing Address - Fax:313-866-5749
Practice Address - Street 1:2301 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3958
Practice Address - Country:US
Practice Address - Phone:313-866-9973
Practice Address - Fax:313-866-5749
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704102288363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4519204Medicaid