Provider Demographics
NPI:1558859504
Name:HAMILTON, ROCHELLE DIANE
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:DIANE
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 1:2802 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5267
Mailing Address - Country:US
Mailing Address - Phone:541-963-3186
Mailing Address - Fax:541-963-3187
Practice Address - Street 1:2802 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-5267
Practice Address - Country:US
Practice Address - Phone:541-963-3186
Practice Address - Fax:541-963-3187
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable