Provider Demographics
NPI:1881836005
Name:HAWKINS, JORDANA WINN (MD)
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:WINN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JORDANA
Other - Middle Name:LAUREN
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5679
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5679
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60279199208000000X
WAML60093774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881836005OtherREGENCE BLUE SHIELD
WA1881836005Medicaid
WA0296376OtherL&I AND CRIME VICTIMS
WA1881836005OtherTRI-WEST (TRICARE)
WA1881836005OtherTRI-WEST (TRICARE)