Healthcare Provider Details

I. General information

NPI: 1902803877
Provider Name (Legal Business Name): PATRICK DALE HAWKINS DNP,ANP, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PATRICK DALE HAWKINS DNP, ANP.NP-C

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 03/27/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 NERREDIA ST
FLINT MI
48532-4807
US

IV. Provider business mailing address

2486 NERREDIA STREET, SUITE E
FLINT MI
48532-4807
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9901
  • Fax: 810-230-9916
Mailing address:
  • Phone: 810-230-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704200480
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: