Provider Demographics
NPI:1811244668
Name:HAWK, DONNA GRACE (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:GRACE
Last Name:HAWK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2222
Mailing Address - Country:US
Mailing Address - Phone:260-437-1996
Mailing Address - Fax:260-724-3346
Practice Address - Street 1:446 GAGE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2222
Practice Address - Country:US
Practice Address - Phone:260-437-1996
Practice Address - Fax:260-724-3346
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28141466A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse