Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 95005626 | CA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP60930255 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP60930255 | WA |
NPI | 1083159479 |
---|---|
Provider Name | Heather Juline Hawk |
First Address | Arcata, CA 95521-6248 |
Second Address | Bellingham, WA 98226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2016 |
Last Update Date | 17/09/2019 |