Healthcare Provider Details

I. General information

NPI: 1710957527
Provider Name (Legal Business Name): MARY M. HAWKINS APRN, FNP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST CHEYENNE REGIONAL MEDICAL CENTER
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

3500 MOFFAT AVE
LOVELAND CO
80538-9211
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-6055
  • Fax: 307-633-7998
Mailing address:
  • Phone: 970-663-9336
  • Fax: 970-669-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number140485
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: