Provider Demographics
NPI:1679818900
Name:HAMILTON, CLOVER ROSEMARIE
Entity type:Individual
Prefix:MS
First Name:CLOVER
Middle Name:ROSEMARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CLOVER
Other - Middle Name:R
Other - Last Name:HAMILTON-PUSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22 FALLKILL AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2104
Mailing Address - Country:US
Mailing Address - Phone:914-489-4155
Mailing Address - Fax:
Practice Address - Street 1:2094 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:914-788-4385
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily