Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 4704165653 | MI |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP3146 | AZ |
NPI | 1427107101 |
---|---|
Provider Name | Mr. Dale Wade Hawkins |
First Address | Tucson, AZ 85746-6016 |
Second Address | Tucson, AZ 85741-3537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366792 | (05) | AZ |
4670866 | (05) | MI |