Provider Demographics
NPI:1811021165
Name:HAMILTON, CARMELLIA MARIE (RN, CDE)
Entity Type:Individual
Prefix:
First Name:CARMELLIA
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 CANYON TRAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135
Mailing Address - Country:US
Mailing Address - Phone:405-200-9372
Mailing Address - Fax:
Practice Address - Street 1:4913 W. RENO
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4919
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069271163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0069271OtherNURSING LICENSE