Individual
MRS. LISA HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.N.P.
Contact information
Practice address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031-1674
(315) 708-0091
(315) 708-0194
Mailing address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031-1674
(315) 708-0190
(315) 488-3284
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F302679-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02410204
—
NY
Enumeration date
02/27/2006
Last updated
06/17/2016
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