Provider Demographics
NPI:1922344100
Name:HAWKINS, LEE ETTA
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:ETTA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:ETTA
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1392 SCENIC CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7319
Mailing Address - Country:US
Mailing Address - Phone:951-657-8986
Mailing Address - Fax:
Practice Address - Street 1:1392 SCENIC CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7319
Practice Address - Country:US
Practice Address - Phone:951-657-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse