Provider Demographics
NPI:1275530024
Name:HAWKINS, DIANE C (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W ST JAMES PL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-9547
Mailing Address - Country:US
Mailing Address - Phone:360-577-7448
Mailing Address - Fax:
Practice Address - Street 1:748 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2315
Practice Address - Country:US
Practice Address - Phone:360-501-3601
Practice Address - Fax:360-501-3648
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00053624163W00000X
WAAP30003064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126458OtherLABOR & IND.
WA8923173OtherCRIME VICTIMS
OR120829Medicaid
WA9624008Medicaid
AB08158Medicare ID - Type Unspecified
OR120829Medicaid
WA8923173OtherCRIME VICTIMS