Individual
SUSAN HAWTHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2918 SUNRIDGE PLACE, IMPERIAL, MO 63052
(636) 296-7704
Mailing address
2918 SUN RIDGE PL, IMPERIAL, MO 63052
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/09/2019
Last updated
05/07/2020
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