Healthcare Provider Details

I. General information

NPI: 1194733899
Provider Name (Legal Business Name): LAURA HAWKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 WAGON WHEEL TRL
LAS CRUCES NM
88005-8713
US

IV. Provider business mailing address

PO BOX 744
FAIRACRES NM
88033-0744
US

V. Phone/Fax

Practice location:
  • Phone: 505-571-8300
  • Fax:
Mailing address:
  • Phone: 505-571-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4384
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: