Provider Demographics
NPI:1861088270
Name:HAMILTON, AMEANNA VUSU
Entity type:Individual
Prefix:
First Name:AMEANNA
Middle Name:VUSU
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 1:6500 OLD MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2356
Mailing Address - Country:US
Mailing Address - Phone:618-857-2170
Mailing Address - Fax:618-857-2170
Practice Address - Street 1:6500 OLD MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2356
Practice Address - Country:US
Practice Address - Phone:618-857-2170
Practice Address - Fax:618-857-2170
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001843171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001843OtherHOMECARE SERVICE