Healthcare Provider Details

I. General information

NPI: 1881637544
Provider Name (Legal Business Name): LEE ANN HAWKINS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEE ANN BLAZEK APRN, BC

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD FL 4
PORTLAND OR
97223-5500
US

IV. Provider business mailing address

10260 SW GREENBURG RD FL 4
PORTLAND OR
97223-5500
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 646-941-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number209003516(41202399)
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number60677450
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number201909919
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: