Provider Demographics
NPI:1265705404
Name:HAMILTON, HEATHER N (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
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 1:4000 W WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4264
Mailing Address - Country:US
Mailing Address - Phone:765-289-5006
Mailing Address - Fax:765-741-4658
Practice Address - Street 1:4000 W WOODWAY DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4264
Practice Address - Country:US
Practice Address - Phone:765-289-5006
Practice Address - Fax:765-741-4658
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003867A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300029579AMedicaid
ININ1953002OtherMEDICARE
IN000000880443OtherANTHEM BCBS