1225001977 NPI number — MRS. ELIZABETH ANNE HAWTHORNE MSPT

Table of content: MRS. ELIZABETH ANNE HAWTHORNE MSPT (NPI 1225001977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225001977 NPI number — MRS. ELIZABETH ANNE HAWTHORNE MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWTHORNE
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAWTHORNE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225001977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 402 BOX 919
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
06371917422
Provider Business Mailing Address Fax Number:
06371867058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CMR 402 BOX 919
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
06371917422
Provider Business Practice Location Address Fax Number:
06371867058
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501010275 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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