=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568245322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA MARGARET HAWKINS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2023
-----------------------------------------------------
Last Update Date | 08/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2353 S CUSTER RD STE 1
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-241-4855
-----------------------------------------------------
Fax | 734-241-4875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 BROOKSIDE DR E
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49221-3248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-902-8676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 2902012394
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------