Provider Demographics
NPI:1396458345
Name:HAWK, DONNA SUE I
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SUE
Last Name:HAWK
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 COON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SMITHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:42081-9103
Mailing Address - Country:US
Mailing Address - Phone:270-508-0905
Mailing Address - Fax:
Practice Address - Street 1:2620 PERKINS CREEK DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7494
Practice Address - Country:US
Practice Address - Phone:270-444-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1043925163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse