Provider Demographics
NPI:1588028468
Name:HAWTHORN, CONNIE (RN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HAWTHORN
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 1:5245 ERIE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8505
Mailing Address - Country:US
Mailing Address - Phone:330-933-0905
Mailing Address - Fax:234-678-6919
Practice Address - Street 1:6694 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-9201
Practice Address - Country:US
Practice Address - Phone:330-825-5202
Practice Address - Fax:234-678-6919
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN255689163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)