Individual
TIFFANY HAWTHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9025 S MARSHFIELD AVE, CHICAGO, IL 60620-5546
(773) 654-8112
Mailing address
9025 S MARSHFIELD AVE, CHICAGO, IL 60620-5546
(773) 654-8112
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
041478292
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.030813
IL
Other
Enumeration date
10/08/2024
Last updated
03/07/2025
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