Provider Demographics
NPI:1154177749
Name:HAWKINS, D'ANDRA LATRICE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:D'ANDRA
Middle Name:LATRICE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:MS
Other - First Name:D'ANDRA
Other - Middle Name:LATRICE
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:21224 KELLY RD UNIT #5
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-328-7287
Mailing Address - Fax:586-846-3143
Practice Address - Street 1:21225 KELLY RD UNIT #5F
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-328-7287
Practice Address - Fax:586-846-3143
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy