Provider Demographics
NPI:1093004822
Name:HAWKINS, JENAE MARIE (RD)
Entity type:Individual
Prefix:
First Name:JENAE
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677000
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-7000
Mailing Address - Country:US
Mailing Address - Phone:530-876-2116
Mailing Address - Fax:530-876-3181
Practice Address - Street 1:5974 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5509
Practice Address - Country:US
Practice Address - Phone:530-876-2116
Practice Address - Fax:530-876-3181
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10197081133V00000X
CA1006053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFF559ZMedicare UPIN