Provider Demographics
NPI:1144777673
Name:HAWKS, HOLLY EVE
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:EVE
Last Name:HAWKS
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 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-779-4444
Mailing Address - Fax:360-874-5959
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-779-4444
Practice Address - Fax:360-874-5959
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60692869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2068521Medicaid