Healthcare Provider Details

I. General information

NPI: 1689300196
Provider Name (Legal Business Name): JENNIFER L HAWKINS BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

500 W FORT ST
BOISE ID
83702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1052
Mailing address:
  • Phone: 208-422-1000
  • Fax: 208-422-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201140253RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number70217
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: