Basic Information
| Provider Information | |||||||||
| NPI: | 1275530024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 W ST JAMES PL | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986329547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605777448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 748 14TH AVE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605013601 | ||||||||
| FaxNumber: | 3605013648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00053624 | WA | X | Nursing Service Providers | Registered Nurse | 363LA2200X | AP30003064 | WA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 126458 | 01 | WA | LABOR & IND. | OTHER | 8923173 | 01 | WA | CRIME VICTIMS | OTHER | 120829 | 05 | OR | MEDICAID | 9624008 | 05 | WA | MEDICAID |