Provider Demographics
NPI:1477830412
Name:HAWES, PATRICE SHANTE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:SHANTE
Last Name:HAWES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:PATRICE
Other - Middle Name:SHANTE
Other - Last Name:HAWES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BUILDING B 3RD FLOOR
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:8401 CLAUDE THOMAS RD STE 21D
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1476
Practice Address - Country:US
Practice Address - Phone:937-743-5965
Practice Address - Fax:937-743-5975
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311213163W00000X
OHAPRN.CNP.023970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty