Provider Demographics
NPI:1992001432
Name:HAMILTON, EDIE R (PA-C)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1625
Mailing Address - Country:US
Mailing Address - Phone:808-242-6464
Mailing Address - Fax:808-984-7444
Practice Address - Street 1:110 E KAAHUMANU AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2118
Practice Address - Country:US
Practice Address - Phone:088-711-7308
Practice Address - Fax:808-984-7444
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105892363A00000X
HIAMD-976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant