Provider Demographics
NPI:1598344384
Name:HAWES-GLENESK, PETRA D (NBC-HWC)
Entity Type:Individual
Prefix:MS
First Name:PETRA
Middle Name:D
Last Name:HAWES-GLENESK
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4596 ECHO SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7605
Mailing Address - Country:US
Mailing Address - Phone:916-870-0846
Mailing Address - Fax:
Practice Address - Street 1:874 57TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3327
Practice Address - Country:US
Practice Address - Phone:916-870-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date: