Healthcare Provider Details

I. General information

NPI: 1093849564
Provider Name (Legal Business Name): TIMOTHY PARKER HAWBAKER N.P., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E MAIN ST
CEDAREDGE CO
81413-3331
US

IV. Provider business mailing address

175 E MAIN ST
CEDAREDGE CO
81413-3331
US

V. Phone/Fax

Practice location:
  • Phone: 970-856-4729
  • Fax:
Mailing address:
  • Phone: 970-856-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number928
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0992671-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: