Provider Demographics
NPI:1548559636
Name:HAWKINS, DARCEY JADENE (LMP)
Entity Type:Individual
Prefix:
First Name:DARCEY
Middle Name:JADENE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 208TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4760
Mailing Address - Country:US
Mailing Address - Phone:253-441-0978
Mailing Address - Fax:
Practice Address - Street 1:5420 208TH STREET CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4760
Practice Address - Country:US
Practice Address - Phone:253-441-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60212142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist