Provider Demographics
NPI:1386634368
Name:HAWKINSON, ILENE BIRNELL (PA)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:BIRNELL
Last Name:HAWKINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 SUNSET BLVD
Mailing Address - Street 2:P O BOX 758
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-0758
Mailing Address - Country:US
Mailing Address - Phone:406-271-3211
Mailing Address - Fax:406-271-3912
Practice Address - Street 1:805 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1717
Practice Address - Country:US
Practice Address - Phone:406-271-3211
Practice Address - Fax:406-271-3912
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000070708Medicare Oscar/Certification