Healthcare Provider Details

I. General information

NPI: 1396160420
Provider Name (Legal Business Name): KATRINA HAWKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 MOUNT OVERLOOK AVE
CLEVELAND OH
44120-1025
US

IV. Provider business mailing address

11731 MOUNT OVERLOOK AVE
CLEVELAND OH
44120-1025
US

V. Phone/Fax

Practice location:
  • Phone: 216-795-8097
  • Fax: 216-707-5175
Mailing address:
  • Phone: 216-795-8097
  • Fax: 216-707-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN194665
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: