Individual
WENDY HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4510 SW HALL BLVD, BEAVERTON, OR 97005
(503) 644-1171
(503) 643-7443
Mailing address
6 CENTERPOINTE DR, STE 200, LAKE OSWEGO, OR 97035-8660
(503) 797-2254
(503) 914-0335
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
090000324N3
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276415
—
OR
01
—
500011385
RR MEDICARE
—
Enumeration date
05/17/2006
Last updated
03/07/2023
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