Provider Demographics
NPI:1659932986
Name:HAWTHORNE, HAVEN ALEXANDER
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:ALEXANDER
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BILLI
Other - Middle Name:JEAN SUE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2327 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1782
Mailing Address - Country:US
Mailing Address - Phone:541-223-1957
Mailing Address - Fax:
Practice Address - Street 1:1700 AIRPORT WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1618
Practice Address - Country:US
Practice Address - Phone:206-223-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician