Provider Demographics
NPI:1447408760
Name:HAMILTON, ROSA L (ANP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:STE. 404
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-2171
Mailing Address - Fax:207-795-8330
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:STE. 404
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-2171
Practice Address - Fax:207-795-8330
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81941363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30347107Medicaid
ME433501199Medicaid
ME000920201Medicare PIN
NH30347107Medicaid
ME000920203Medicare PIN