Individual
MRS. TRACY HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
112 MANSFIELD AVE, WILLIMANTIC, CT 06226-2045
(860) 456-9116
Mailing address
112 MANSFIELD AVE, WILLIMANTIC, CT 06226-2045
(860) 456-9116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001685
CT
Other
Enumeration date
01/09/2006
Last updated
08/12/2009
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