Provider Demographics
NPI:1003778820
Name:HAMILTON, AMY NICOLE
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICOLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4132
Mailing Address - Country:US
Mailing Address - Phone:701-237-3372
Mailing Address - Fax:701-237-3372
Practice Address - Street 1:338 19TH ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4132
Practice Address - Country:US
Practice Address - Phone:701-237-3372
Practice Address - Fax:701-237-3372
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QD1600X, 171400000X, 172A00000X, 174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No171400000XOther Service ProvidersHealth & Wellness Coach
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals