Provider Demographics
NPI:1083179907
Name:HAWKINS, KAREN LYNN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 MAPLEWOOD RD APT I104
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1846
Mailing Address - Country:US
Mailing Address - Phone:440-305-2975
Mailing Address - Fax:
Practice Address - Street 1:6316 MAPLEWOOD RD APT I104
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-1846
Practice Address - Country:US
Practice Address - Phone:440-305-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401597261213376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290511Medicaid
OH006996001-01OtherUNITED HEALTHCARE
OHCS1817000143OtherCARESOURCE