Individual
MR. JEREMY A HAWK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
441 N WABASH AVE, MARION, IN 46952-2612
(765) 660-7600
(765) 651-7313
Mailing address
330 NORTH WABASH, SUITE G20, MARION, IN 46952-2600
(765) 660-6411
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002734A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000594131
ANTHEM
—
05
—
200922890
—
IN
Enumeration date
11/25/2008
Last updated
10/20/2020
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