Provider Demographics
NPI:1558492330
Name:HAMILTON, LULA BELLE
Entity Type:Individual
Prefix:
First Name:LULA
Middle Name:BELLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41250 BUTTERNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7431
Mailing Address - Country:US
Mailing Address - Phone:440-458-4183
Mailing Address - Fax:440-458-4183
Practice Address - Street 1:40368 STATE ROUTE 303
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9703
Practice Address - Country:US
Practice Address - Phone:440-355-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4700783171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4700783OtherCONTRACTOR NUMBER