Provider Demographics
NPI:1659587079
Name:HAWLEY, JANIE MARIE
Entity Type:Individual
Prefix:MRS
First Name:JANIE
Middle Name:MARIE
Last Name:HAWLEY
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 1:402 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9750
Mailing Address - Country:US
Mailing Address - Phone:740-743-3090
Mailing Address - Fax:
Practice Address - Street 1:6495 RUSH CREEK RD.
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076
Practice Address - Country:US
Practice Address - Phone:740-743-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2520249Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER