Provider Demographics
NPI:1558798702
Name:HATHAWAY, MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NEW RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1281
Mailing Address - Country:US
Mailing Address - Phone:609-788-8593
Mailing Address - Fax:609-904-6929
Practice Address - Street 1:222 NEW RD STE 201
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1281
Practice Address - Country:US
Practice Address - Phone:609-788-8593
Practice Address - Fax:609-904-6929
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC827363AM0700X
NJ25MP00320600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical