Provider Demographics
NPI:1619180395
Name:HAMLIN, ANNETTE ROSE
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:ROSE
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:BELITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 E PORTER ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2427
Mailing Address - Country:US
Mailing Address - Phone:660-627-2506
Mailing Address - Fax:
Practice Address - Street 1:200 E PORTER ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2427
Practice Address - Country:US
Practice Address - Phone:660-627-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging