Individual
JENNIFER CHRISTINE HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14000 FAIRVIEW DR, BURNSVILLE, MN 55337-5713
(952) 993-8700
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
76819
MN
390200000X
Student in an Organized Health Care Education/Training Program
X000-057-306-400
MN
Other
Enumeration date
04/21/2021
Last updated
07/19/2024
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