Provider Demographics
NPI:1750423414
Name:HAMILTON, OLLIE ANNE (CPM, LDEM)
Entity type:Individual
Prefix:MRS
First Name:OLLIE
Middle Name:ANNE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:MRS
Other - First Name:OLLIE
Other - Middle Name:A
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LDEM
Mailing Address - Street 1:513 27TH ST N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2046
Mailing Address - Country:US
Mailing Address - Phone:406-453-4915
Mailing Address - Fax:406-453-4915
Practice Address - Street 1:513 27TH ST N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-453-4915
Practice Address - Fax:406-453-4915
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8006243958Medicaid