Provider Demographics
NPI:1801841697
Name:HAWORTH, SANDRA KAY (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SANDY POINT RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2582
Mailing Address - Country:US
Mailing Address - Phone:508-947-4993
Mailing Address - Fax:
Practice Address - Street 1:942 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5567
Practice Address - Country:US
Practice Address - Phone:508-583-3005
Practice Address - Fax:508-583-9809
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145870363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2432OtherBLUE CROSS & BLUE SHIELD
MANP2432OtherBLUE CROSS & BLUE SHIELD
P06481Medicare UPIN