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Individual

LISA MARIE HATHAWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C, RD

Contact information

Practice address
2819 GREAT NORTHERN LOOP STE 100, MISSOULA, MT 59808-1750
(406) 282-3495
Mailing address
2819 GREAT NORTHERN LOOP STE 100, MISSOULA, MT 59808-1750
(406) 327-3350
(406) 327-3355

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
86048867
MT
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-94043
MT
363AM0700X
Medical Physician Assistant
1176977
NV

Other

Enumeration date
01/14/2021
Last updated
10/15/2025
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