Provider Demographics
NPI:1881009009
Name:HATHAWAY, DEANNA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:NICOLE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:NICOLE
Other - Last Name:PACKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2 POND PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4354
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-335-6047
Practice Address - Street 1:2 POND PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4354
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-335-6047
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant