Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP7573 | AZ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN138878 | AZ |
NPI | 1033508635 |
---|---|
Provider Name | Shuntelle Hawk |
First Address | Phoenix, AZ 85012-2929 |
Second Address | Mesa, AZ 85209-3378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 19/06/2020 |