Healthcare Provider Details

I. General information

NPI: 1447450168
Provider Name (Legal Business Name): TAWNYA MARIE HAWBAKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 BIG HORN AVE
SHERIDAN WY
82801-5913
US

IV. Provider business mailing address

473 N CARRINGTON AVE
BUFFALO WY
82834-1617
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-4416
  • Fax:
Mailing address:
  • Phone: 307-684-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21213
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: