Provider Demographics
NPI:1437691706
Name:HAMILTON, JUSTIN (LVN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MINEOLA ST
Mailing Address - Street 2:
Mailing Address - City:INGRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78025-3025
Mailing Address - Country:US
Mailing Address - Phone:785-313-0275
Mailing Address - Fax:
Practice Address - Street 1:129 MINEOLA ST
Practice Address - Street 2:
Practice Address - City:INGRAM
Practice Address - State:TX
Practice Address - Zip Code:78025-3025
Practice Address - Country:US
Practice Address - Phone:785-313-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326990164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse