Provider Demographics
NPI:1245581867
Name:HAWKINS, ALETA
Entity type:Individual
Prefix:
First Name:ALETA
Middle Name:
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 1:27555 DIEHL RD
Mailing Address - Street 2:ENTRANCE B
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3849
Mailing Address - Country:US
Mailing Address - Phone:630-646-3950
Mailing Address - Fax:630-548-6832
Practice Address - Street 1:20 S WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4947
Practice Address - Country:US
Practice Address - Phone:630-527-3645
Practice Address - Fax:815-293-2902
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant