Healthcare Provider Details

I. General information

NPI: 1144777673
Provider Name (Legal Business Name): HOLLY EVE HAWKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22180 OLYMPIC COLLEGE WAY NW STE 102
POULSBO WA
98370-6664
US

IV. Provider business mailing address

22180 OLYMPIC COLLEGE WAY NW STE 102
POULSBO WA
98370-6664
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-4444
  • Fax: 360-874-5959
Mailing address:
  • Phone: 360-779-4444
  • Fax: 360-874-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60692869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: