Provider Demographics
NPI:1851693915
Name:HAMBLIN, AMI M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:M
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10207 W COUNTRY PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8450
Mailing Address - Country:US
Mailing Address - Phone:623-478-6126
Mailing Address - Fax:
Practice Address - Street 1:10207 W COUNTRY PLACE BLVD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8450
Practice Address - Country:US
Practice Address - Phone:623-478-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse