Provider Demographics
NPI:1093890055
Name:HAWTHORNE, CHRISTINA M (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:STE 470
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-739-8863
Mailing Address - Fax:314-739-6448
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:STE 470
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-8863
Practice Address - Fax:314-739-6448
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000559213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2700497OtherUHC
MO49331OtherBLUE CROSS
MO1984900OtherCIGNA
MO303231500Medicaid
MOCK3051OtherRR MEDICARE
MO2700497OtherUHC
MO303231500Medicaid