Healthcare Provider Details

I. General information

NPI: 1922057710
Provider Name (Legal Business Name): NANCI L. HAWKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 CLINTON ST
WATERTOWN NY
13601-3602
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-6262
  • Fax: 315-782-5181
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-476-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number203593
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number203593
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: