MEDICARE: SALONDA HAWKINS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F10231059	IN

General Provider Information

NPI Number	:	1154140333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALONDA HAWKINS NP

Provider Business Mailing Address
First Line	:	2626 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1215
Country	:	US
Telephone Number	:	260-638-7267
Fax Number	:	260-264-6769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	02/08/2025

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