Basic Information
| Provider Information | |||||||||
| NPI: | 1114568235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMILTON-GRABLE | ||||||||
| FirstName: | CHIMERE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2521 N ELMS RD | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484339423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104875521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2521 N ELMS RD | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484339423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104875521 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2019 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 4703121244 | MI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.