Provider Demographics
NPI:1386663177
Name:HAMILTON, JAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W ROYAL PALM RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5657
Mailing Address - Country:US
Mailing Address - Phone:602-432-1149
Mailing Address - Fax:602-944-0688
Practice Address - Street 1:1825 E NORTHERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3940
Practice Address - Country:US
Practice Address - Phone:602-432-1149
Practice Address - Fax:602-944-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN038496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health