1023232139 NPI number — DR. SHELLEY YERGER HAWKINS DSN, APRN-BC, FAANP

Table of content: DR. SHELLEY YERGER HAWKINS DSN, APRN-BC, FAANP (NPI 1023232139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023232139 NPI number — DR. SHELLEY YERGER HAWKINS DSN, APRN-BC, FAANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
SHELLEY
Provider Middle Name:
YERGER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSN, APRN-BC, FAANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023232139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CHURCH ST S
Provider Second Line Business Mailing Address:
#271
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06519-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-999-9029
Provider Business Mailing Address Fax Number:
203-785-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CHURCH ST S
Provider Second Line Business Practice Location Address:
#271
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-999-9029
Provider Business Practice Location Address Fax Number:
203-785-6455
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  004246 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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