Provider Demographics
NPI:1699597153
Name:HAWKINS-SLUE, MARY (PHHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAWKINS-SLUE
Suffix:
Gender:F
Credentials:PHHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 106TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2538
Mailing Address - Country:US
Mailing Address - Phone:312-887-2226
Mailing Address - Fax:
Practice Address - Street 1:300 W 106TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2538
Practice Address - Country:US
Practice Address - Phone:312-887-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030586363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health