Provider Demographics
NPI:1659323509
Name:HAWKINS, DIANNE LYNNE (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:LYNNE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 OLD CAMDEN SQ
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7952
Mailing Address - Country:US
Mailing Address - Phone:608-241-3568
Mailing Address - Fax:
Practice Address - Street 1:2646 OLD CAMDEN SQ
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7952
Practice Address - Country:US
Practice Address - Phone:608-241-3568
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39874200Medicaid