Healthcare Provider Details

I. General information

NPI: 1275530024
Provider Name (Legal Business Name): DIANE C HAWKINS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 14TH AVE
LONGVIEW WA
98632-2315
US

IV. Provider business mailing address

229 W ST JAMES PL
LONGVIEW WA
98632-9547
US

V. Phone/Fax

Practice location:
  • Phone: 360-501-3601
  • Fax: 360-501-3648
Mailing address:
  • Phone: 360-577-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00053624
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: