Individual
MR. BLAKE HAWK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 523-3193
Mailing address
202 ORCHARD PARK DR, WAKARUSA, IN 46573-9738
(574) 354-7556
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28198864A
IN
367500000X
Certified Registered Nurse Anesthetist
RN.400991
OH
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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