Healthcare Provider Details

I. General information

NPI: 1710616875
Provider Name (Legal Business Name): KARLA JEAN HAWKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

1405 NW 136TH ST
VANCOUVER WA
98685-1687
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-5256
  • Fax:
Mailing address:
  • Phone: 520-204-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61401315
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61401315
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201393767RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60425049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: