Provider Demographics
NPI:1811798630
Name:HAMANAKA, AMETHYST
Entity type:Individual
Prefix:MS
First Name:AMETHYST
Middle Name:
Last Name:HAMANAKA
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:AMETHYST
Other - Middle Name:
Other - Last Name:PERRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 CITY CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2981
Mailing Address - Country:US
Mailing Address - Phone:936-202-5202
Mailing Address - Fax:
Practice Address - Street 1:925 CITY CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2981
Practice Address - Country:US
Practice Address - Phone:936-202-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program