Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2016128 | MN |
NPI | 1003109653 |
---|---|
Provider Name | Anne Hawkins |
First Address | Minneapolis, MN 55417-2535 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 17/05/2015 |