Provider Demographics
NPI:1013231869
Name:HAWKINS, JOELNELL J (LMP)
Entity Type:Individual
Prefix:
First Name:JOELNELL
Middle Name:J
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JOELNELL
Other - Middle Name:J
Other - Last Name:YOUNGBLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1018 S GEIGER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1406
Mailing Address - Country:US
Mailing Address - Phone:253-226-3144
Mailing Address - Fax:
Practice Address - Street 1:1018 S GEIGER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1406
Practice Address - Country:US
Practice Address - Phone:253-226-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60072924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist