Healthcare Provider Details

I. General information

NPI: 1114285301
Provider Name (Legal Business Name): CHARLOTTE HAWS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12123 SW 69TH AVE
TIGARD OR
97223-8514
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 240
VANCOUVER WA
98683-5508
US

V. Phone/Fax

Practice location:
  • Phone: 971-708-7600
  • Fax: 971-371-5230
Mailing address:
  • Phone: 360-597-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA157890
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2018013
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier500646365
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: