Provider Demographics
NPI:1134743271
Name:HAWKINSON, JUSTYNE JUDITH
Entity type:Individual
Prefix:
First Name:JUSTYNE
Middle Name:JUDITH
Last Name:HAWKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-2485
Mailing Address - Country:US
Mailing Address - Phone:320-223-1791
Mailing Address - Fax:
Practice Address - Street 1:25 1ST AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1598
Practice Address - Country:US
Practice Address - Phone:888-250-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2460107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse