Provider Demographics
NPI:1033258231
Name:HAWTHORNE, DELORES G (RN)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:G
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2504
Mailing Address - Country:US
Mailing Address - Phone:318-362-3339
Mailing Address - Fax:318-362-3336
Practice Address - Street 1:4800 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6412
Practice Address - Country:US
Practice Address - Phone:318-362-3339
Practice Address - Fax:318-362-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN062118163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult