Provider Demographics
NPI:1811346422
Name:HAWK, MAXINE VERNETTE (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:VERNETTE
Last Name:HAWK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39061 COMMONS DR.
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-729-8915
Mailing Address - Fax:
Practice Address - Street 1:39061 COMMONS DR.
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:734-729-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG1015138363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology