Provider Demographics
NPI:1013109677
Name:HAWKINS, ETHEL MARIE (LVN)
Entity Type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 E ARABELLA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3915
Mailing Address - Country:US
Mailing Address - Phone:562-786-4994
Mailing Address - Fax:562-630-3588
Practice Address - Street 1:3713 E ARABELLA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3915
Practice Address - Country:US
Practice Address - Phone:562-786-4994
Practice Address - Fax:562-630-3588
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN136932164X00000X, 2278S1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA08162007778841OtherTRACKING NUMBER
CA005100OtherRVN
CA164X00000XOtherTAXONONY
CAEPS-016990OtherPROVDER NUMBER