MEDICARE: DOMINIQUE T HAWKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1629603311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE T HAWKINS

Provider Business Mailing Address
First Line	:	9640 BARREL HOUSE RD APT B
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-1524
Country	:	US
Telephone Number	:	240-581-0792
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 WAYNE PL SE APT 107
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-6120
Country	:	US
Telephone Number	:	202-846-7232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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