Provider Demographics
NPI:1487736476
Name:HAWKINS, MICHELLE (MSN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 WYNWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8260
Mailing Address - Country:US
Mailing Address - Phone:614-873-1356
Mailing Address - Fax:
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:510
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-464-0788
Practice Address - Fax:614-464-0295
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09080363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicaid
OHNP22681Medicare PIN