MEDICARE: PETRONE HAWKINS 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	163W00000X	Registered Nurse	83202	NV

General Provider Information

NPI Number	:	1669043451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRONE HAWKINS RN

Provider Business Mailing Address
First Line	:	3232 N CAMPBELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6165
Country	:	US
Telephone Number	:	702-752-2114
Fax Number	:	725-205-9346

Provider Business Practice Location Address
First Line	:	3232 N CAMPBELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6165
Country	:	US
Telephone Number	:	702-752-2114
Fax Number	:	725-205-9346

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	07/02/2021

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