Healthcare Provider Details

I. General information

NPI: 1730189036
Provider Name (Legal Business Name): ANNA HAWKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 FILLMORE STREET
TWIN FALLS ID
83301-3015
US

IV. Provider business mailing address

1880 FILLMORE STREET
TWIN FALLS ID
83301-5029
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-8386
  • Fax: 208-735-0434
Mailing address:
  • Phone: 208-735-8386
  • Fax: 208-735-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP710A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: