Provider Demographics
NPI:1750597803
Name:CAROL J HATHAWAY MN ARNP INC
Entity type:Organization
Organization Name:CAROL J HATHAWAY MN ARNP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MN ARNP
Authorized Official - Phone:360-452-1775
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0113
Mailing Address - Country:US
Mailing Address - Phone:360-452-1775
Mailing Address - Fax:360-452-1722
Practice Address - Street 1:113 S EUNICE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3333
Practice Address - Country:US
Practice Address - Phone:360-452-1775
Practice Address - Fax:360-452-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8803903Medicare PIN