Provider Demographics
NPI:1558898619
Name:HAWKINS, STACIE (RN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:ARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3223 E PALMER WASILLA HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7277
Mailing Address - Country:US
Mailing Address - Phone:907-352-6632
Mailing Address - Fax:
Practice Address - Street 1:3223 E PALMER WASILLA HWY STE 3
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7277
Practice Address - Country:US
Practice Address - Phone:907-352-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR35892163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse