Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71001487A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71001487A | IN |
NPI | 1063507374 |
---|---|
Provider Name | Ms. Candice R Hamilton |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000612784 | ANTHEM (01) | |
200939930 | (05) | IN |