Provider Demographics
NPI:1023410735
Name:HAMILTON, LANA (MT)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 CLAYBURNE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8160
Mailing Address - Country:US
Mailing Address - Phone:870-761-7544
Mailing Address - Fax:
Practice Address - Street 1:2641 CLAYBURNE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8160
Practice Address - Country:US
Practice Address - Phone:870-761-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN38517246QM0706X
HI4363246QM0706X
LACLP.201833-GEN246QM0706X
MT1386CLS246QM0706X
NV1539TCL-4246QM0706X
ND05-437982-I246QM0706X
TN21388246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist