Healthcare Provider Details

I. General information

NPI: 1114115201
Provider Name (Legal Business Name): DEBRA LYNN HAWKINS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILMOT RD # 216
DEERFIELD IL
60015-4620
US

IV. Provider business mailing address

11 E 75TH ST
CHICAGO IL
60619-1601
US

V. Phone/Fax

Practice location:
  • Phone: 217-709-2204
  • Fax: 217-709-2345
Mailing address:
  • Phone: 773-496-5048
  • Fax: 773-224-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209006507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: