MEDICARE: MS. ETHEL MARIE HAWKINS LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN136932	CA
2	2278S1500X	SNF/Subacute Care Certified Respiratory Therapist	VN136932	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08162007778841	OTHER	CA	TRACKING NUMBER
2	005100	OTHER	CA	RVN
3	164X00000X	OTHER	CA	TAXONONY
4	EPS-016990	OTHER	CA	PROVDER NUMBER

General Provider Information

NPI Number	:	1013109677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ETHEL MARIE HAWKINS LVN

Provider Business Mailing Address
First Line	:	3713 E ARABELLA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3915
Country	:	US
Telephone Number	:	562-786-4994
Fax Number	:	562-630-3588

Provider Business Practice Location Address
First Line	:	3713 E ARABELLA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3915
Country	:	US
Telephone Number	:	562-786-4994
Fax Number	:	562-630-3588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	11/11/2008

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