Healthcare Provider Details

I. General information

NPI: 1588593883
Provider Name (Legal Business Name): IVY ANNE HAWKSFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HUNTINGTON AVE
BOSTON MA
02115-5000
US

IV. Provider business mailing address

37 HILLSIDE ST APT 1
BOSTON MA
02120-3399
US

V. Phone/Fax

Practice location:
  • Phone: 617-373-2000
  • Fax:
Mailing address:
  • Phone: 206-383-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: