Provider Demographics
NPI:1982369930
Name:HAWKINS, RAYVEN C
Entity Type:Individual
Prefix:
First Name:RAYVEN
Middle Name:C
Last Name:HAWKINS
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 1:2657 22ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3413
Mailing Address - Country:US
Mailing Address - Phone:234-804-6660
Mailing Address - Fax:
Practice Address - Street 1:2657 22ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3413
Practice Address - Country:US
Practice Address - Phone:234-804-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251X00000X
OH172A00000X, 251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No251X00000XAgenciesSupports Brokerage