Provider Demographics
NPI:1861866410
Name:HAWKINS-FISHER, LEA (LMT # 3304)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:HAWKINS-FISHER
Suffix:
Gender:F
Credentials:LMT # 3304
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:LA
Mailing Address - Zip Code:71447-4023
Mailing Address - Country:US
Mailing Address - Phone:225-931-7294
Mailing Address - Fax:
Practice Address - Street 1:1024 3RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8343
Practice Address - Country:US
Practice Address - Phone:225-931-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist