Basic Information
| Provider Information | |||||||||
| NPI: | 1558091587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | CALUMBINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAMILTON | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | CALUMBINE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN, FNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3987 BUCKEYE LN APT 2 | ||||||||
| Address2: | |||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997031622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893902962 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1717 W COWLES ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074516682 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2022 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 196730 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WC0200X | 163754 | AK | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 146L00000X | P095433 | NC | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 163W00000X | 163754 | AK | N | Nursing Service Providers | Registered Nurse | 163W00000X | 296823 | NC | N | Nursing Service Providers | Registered Nurse |
No ID Information.