Provider Demographics
NPI:1992208896
Name:HAWKINS, ROSE ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:ANN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-4750
Practice Address - Fax:502-629-4617
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57903208000000X
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program