Provider Demographics
NPI:1629517727
Name:HAWTHORN, ANNETTE KATHRYN
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:KATHRYN
Last Name:HAWTHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 MIAMISBURG CENTERVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3706
Mailing Address - Country:US
Mailing Address - Phone:937-439-5252
Mailing Address - Fax:937-439-9242
Practice Address - Street 1:2591 MIAMISBURG CENTERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3706
Practice Address - Country:US
Practice Address - Phone:937-439-5252
Practice Address - Fax:937-439-9242
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0516185363LF0000X
OHAPRN.CNP.020094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227532Medicaid