Provider Demographics
NPI:1043732399
Name:HAWKINS, VERNELL (STNA)
Entity Type:Individual
Prefix:
First Name:VERNELL
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4878 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2012
Mailing Address - Country:US
Mailing Address - Phone:216-338-1200
Mailing Address - Fax:
Practice Address - Street 1:1745 HAYDEN AVE APT 1
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3833
Practice Address - Country:US
Practice Address - Phone:216-338-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400512250605376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty