Healthcare Provider Details

I. General information

NPI: 1992284590
Provider Name (Legal Business Name): SEDELL HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

29980 FM 2978 RD APT 2505
MAGNOLIA TX
77354-4127
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-5598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number332761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: