Individual
MRS. JENNY VIVIAN HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8600 MEXICO RD, O FALLON, MO 63366-7507
(636) 202-0721
(636) 600-5041
Mailing address
8600 MEXICO RD, O FALLON, MO 63366-7507
(636) 202-0721
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2013031244
MO
363LF0000X
Family Nurse Practitioner
Primary
20180009355
MO
Other
Enumeration date
11/03/2017
Last updated
12/16/2024
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