Basic Information
| Provider Information | |||||||||
| NPI: | 1659818268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | CINARDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PNP-PC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 21444 CARMEAN WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199474572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028551233 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21444 CARMEAN WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199474572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028551233 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2017 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 10/02/2017 | ||||||||
| NPIReactivationDate: | 11/02/2017 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L1-0040450 | DE | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN619459 | PA | N | Nursing Service Providers | Registered Nurse | 363LP0200X | SP017140 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | LJ-0000350 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1659818268 | 05 | DE | MEDICAID |