Individual
TINA M HATHWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-1700
(414) 955-0072
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-1700
(414) 955-0072
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2801-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346529674
—
WI
Enumeration date
08/04/2011
Last updated
12/20/2023
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