Healthcare Provider Details

I. General information

NPI: 1285519157
Provider Name (Legal Business Name): BRANDY DAUN HAWKINS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDY DAUN FORTNER

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 W RUMBLE RD
MODESTO CA
95350-0219
US

IV. Provider business mailing address

2410 JANNA AVE
MODESTO CA
95350-1910
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-9892
  • Fax:
Mailing address:
  • Phone: 209-529-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95131280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: