Provider Demographics
NPI:1942315767
Name:HAMILTON, ANGELA R (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
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 1:727 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-8411
Mailing Address - Fax:
Practice Address - Street 1:727 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002088A363LF0000X
IL209-009264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811970NMedicaid
INP00818715OtherRAILROAD MEDICARE
IN200811970DMedicaid
000000391742OtherANTHEM
IN200811970AMedicaid
P00403874OtherRAILROAD MEDICARE PIN
INP00818715OtherRAILROAD MEDICARE
IN859940EMedicare PIN
IN200811970DMedicaid
IN859930GMedicare PIN
IN200811970NMedicaid
IN192770OOOOMedicare PIN