Provider Demographics
NPI:1225747900
Name:VIGIL-HAWK, STEFANIE (PWS)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:VIGIL-HAWK
Suffix:
Gender:F
Credentials:PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 ONYX AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7279
Mailing Address - Country:US
Mailing Address - Phone:541-363-1277
Mailing Address - Fax:
Practice Address - Street 1:3206 ONYX AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7279
Practice Address - Country:US
Practice Address - Phone:541-363-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000107632OtherOHA