Provider Demographics
NPI:1083035752
Name:HAWTHORN, MAYA JOY (CPM)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:JOY
Last Name:HAWTHORN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3584
Mailing Address - Country:US
Mailing Address - Phone:540-437-9850
Mailing Address - Fax:
Practice Address - Street 1:1461 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3584
Practice Address - Country:US
Practice Address - Phone:540-437-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000094176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife