MEDICARE: MRS. SHENAKWA HAWKINS APRN, RN

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	363L00000X	Nurse Practitioner	APRN002399	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306384086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHENAKWA HAWKINS APRN, RN

Provider Business Mailing Address
First Line	:	2580 N RANCHO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3361
Country	:	US
Telephone Number	:	725-780-7880
Fax Number	:	725-780-7890

Provider Business Practice Location Address
First Line	:	2580 N RANCHO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3361
Country	:	US
Telephone Number	:	725-780-7880
Fax Number	:	725-780-7890

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

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	04/07/2022

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