Basic Information
| Provider Information | |||||||||
| NPI: | 1093004822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | JENAE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 677000 | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959677000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308762116 | ||||||||
| FaxNumber: | 5308763181 | ||||||||
| Practice Location | |||||||||
| Address1: | 5974 PENTZ RD | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959695509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308762116 | ||||||||
| FaxNumber: | 5308763181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 10197081 | OR | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 1006053 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.