Provider Demographics
NPI:1790286250
Name:LYMAS, HAWA SOPHIA
Entity Type:Individual
Prefix:
First Name:HAWA
Middle Name:SOPHIA
Last Name:LYMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 POLARIS LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2114
Mailing Address - Country:US
Mailing Address - Phone:763-477-1135
Mailing Address - Fax:
Practice Address - Street 1:7865 POLARIS LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2114
Practice Address - Country:US
Practice Address - Phone:763-477-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR207277-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse