Provider Demographics
NPI:1104890235
Name:HAWKINS, GINA (PAC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W HAVENS
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3830
Mailing Address - Country:US
Mailing Address - Phone:605-996-7526
Mailing Address - Fax:605-996-1808
Practice Address - Street 1:818 W HAVENS ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3830
Practice Address - Country:US
Practice Address - Phone:605-996-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0275900001Medicare NSC
SDR02618Medicare UPIN
SDS3350Medicare PIN