Healthcare Provider Details

I. General information

NPI: 1083179907
Provider Name (Legal Business Name): KAREN LYNN HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 MAPLEWOOD RD APT I104
MAYFIELD HTS OH
44124-1846
US

IV. Provider business mailing address

6316 MAPLEWOOD RD APT I104
MAYFIELD HTS OH
44124-1846
US

V. Phone/Fax

Practice location:
  • Phone: 440-305-2975
  • Fax:
Mailing address:
  • Phone: 440-305-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401597261213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: