Provider Demographics
NPI:1972875466
Name:HAWKINS, REBECCA JO (LPN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JO
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WEST CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2808
Mailing Address - Country:US
Mailing Address - Phone:330-680-8102
Mailing Address - Fax:
Practice Address - Street 1:418 W CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2808
Practice Address - Country:US
Practice Address - Phone:330-680-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse