Provider Demographics
NPI:1275135147
Name:HAWKINS, BRIGETTE DENISE
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:DENISE
Last Name:HAWKINS
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 1:37336 CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2018
Mailing Address - Country:US
Mailing Address - Phone:586-422-2879
Mailing Address - Fax:
Practice Address - Street 1:37336 CAMELLIA LN
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2018
Practice Address - Country:US
Practice Address - Phone:586-422-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH252098139589344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi