Individual
MARIE A HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
5985 W STATE ST, BOISE, ID 83703-3039
(208) 853-0071
(208) 853-9422
Mailing address
5985 W STATE ST, BOISE, ID 83703-3039
(208) 853-0071
(208) 853-9422
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N20025
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP1240A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619220621
—
ID
01
—
CS20682
CONTROLLED SUBSTANCE
ID
Enumeration date
10/16/2012
Last updated
03/07/2023
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