Provider Demographics
NPI:1356793731
Name:HAWK, BRANDON (FNP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HAWK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 9TH AVE S UNIT 7164
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-7320
Mailing Address - Country:US
Mailing Address - Phone:406-799-6786
Mailing Address - Fax:
Practice Address - Street 1:603 14TH ST SW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-2633
Practice Address - Country:US
Practice Address - Phone:406-799-6786
Practice Address - Fax:406-206-0769
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-103617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily