Provider Demographics
NPI:1407648462
Name:HAMELIN, JOHANNA PAIGE (RN)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:PAIGE
Last Name:HAMELIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3701
Mailing Address - Country:US
Mailing Address - Phone:518-796-7282
Mailing Address - Fax:
Practice Address - Street 1:41 BAKER RD
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3701
Practice Address - Country:US
Practice Address - Phone:518-796-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564343163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice