Provider Demographics
NPI:1336562982
Name:HAMILTON, RAQUEL M (APRN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 OLD EASTOVER RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29044-9030
Mailing Address - Country:US
Mailing Address - Phone:803-414-9176
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:803-414-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18661363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care