Provider Demographics
NPI:1174180046
Name:HAWKES, MARY LYNNE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNNE
Last Name:HAWKES
Suffix:
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 1:6826 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3550
Mailing Address - Country:US
Mailing Address - Phone:952-454-6513
Mailing Address - Fax:
Practice Address - Street 1:6826 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-3550
Practice Address - Country:US
Practice Address - Phone:952-454-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program