Provider Demographics
NPI:1700309630
Name:HAWKES, NANCY CAROL
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:HAWKES
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 1:3412 GADD CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-2338
Mailing Address - Country:US
Mailing Address - Phone:248-887-4648
Mailing Address - Fax:248-887-4648
Practice Address - Street 1:3412 GADD CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48356-2338
Practice Address - Country:US
Practice Address - Phone:248-887-4648
Practice Address - Fax:248-887-4648
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF630287913253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency