Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2017044030 | MO |
NPI | 1083122113 |
---|---|
Provider Name | Ms. Cheryl V Hamilton |
First Address | Festus, MO 63028-2077 |
Second Address | Kennett, MO 63857-3866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2018 |
Last Update Date | 10/01/2018 |