Healthcare Provider Details

I. General information

NPI: 1346308202
Provider Name (Legal Business Name): LAURA BETH HAWKINS MS, MSN, CNS, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 ROME DR
LAFAYETTE IN
47905-4488
US

IV. Provider business mailing address

500 N 6TH ST
LAFAYETTE IN
47901-1015
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-9394
  • Fax:
Mailing address:
  • Phone: 765-404-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number28093092A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: