Provider Demographics
NPI:1467772756
Name:HAWTHORNE, HEATHER (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-839-2668
Mailing Address - Fax:602-839-2067
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 605
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-839-2668
Practice Address - Fax:602-839-2067
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47224207Q00000X
CA135489207Q00000X
MTMED-PHYS-LIC-44336207Q00000X
NV16279207Q00000X
WAMD60610570207Q00000X
HIMD-18544207Q00000X
NMMD2016-0103207Q00000X
CODR.0056497207Q00000X
WY10556A207Q00000X
ORMD175259207Q00000X
IL036145385207Q00000X
ALMD.36809207Q00000X
IAMD-45057207Q00000X
MN63471207Q00000X
KS04-40567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine