Provider Demographics
NPI:1770727307
Name:HAMEL, JILLIAN K (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:K
Last Name:HAMEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:12728 19TH AVE SE
Practice Address - Street 2:STE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-225-2700
Practice Address - Fax:425-225-2790
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175998363LA2100X
CANP20297363LA2100X
WAAP60477362363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD956706-01 & 02OtherCAREFIRST BC/BS
MDS062-0371OtherCAREFIRST BC/BS REGIONAL
MD417717700Medicaid