Provider Demographics
NPI:1265770838
Name:HATHAWAY, ALISON SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:SUZANNE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:154-658-6791
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:580 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1115
Practice Address - Country:US
Practice Address - Phone:415-593-1136
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP22594363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHG488ZMedicare PIN