Provider Demographics
NPI:1871829309
Name:HAMILTON, LISA MCLEOD (LAC RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MCLEOD
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LAC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37840 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3149
Mailing Address - Country:US
Mailing Address - Phone:301-751-4533
Mailing Address - Fax:
Practice Address - Street 1:37840 INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3149
Practice Address - Country:US
Practice Address - Phone:301-751-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist