Provider Demographics
NPI:1699840173
Name:HAMILTON, LISA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-690-6902
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-690-6902
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33053Medicare UPIN
MANP329903Medicare PIN