Individual
LACIE DIANE HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD-LDN
Contact information
Practice address
1006 S DIVISION ST, CARTERVILLE, IL 62918-1539
(618) 985-4841
(618) 985-8101
Mailing address
PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164004504
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-1816
MEDICARE FQHC NUMBER
IL
05
—
370966854004
—
IL
Enumeration date
08/05/2007
Last updated
01/11/2010
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