Provider Demographics
NPI:1588010771
Name:HAMILTON, KATIE JANE (CNM, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JANE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 HARRIMAN LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4532
Mailing Address - Country:US
Mailing Address - Phone:310-944-0622
Mailing Address - Fax:
Practice Address - Street 1:2604 HARRIMAN LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4532
Practice Address - Country:US
Practice Address - Phone:310-944-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-45264174N00000X
374J00000X
CALM582176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-45264OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS CERTIFICATION NUMBER