Basic Information
| Provider Information | |||||||||
| NPI: | 1467772756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWTHORNE | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N 12TH ST | ||||||||
| Address2: | SUITE 605 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028392668 | ||||||||
| FaxNumber: | 6028392067 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N 12TH ST | ||||||||
| Address2: | SUITE 605 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028392668 | ||||||||
| FaxNumber: | 6028392067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 47224 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 135489 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MED-PHYS-LIC-44336 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16279 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60610570 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-18544 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2016-0103 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0056497 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 10556A | WY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD175259 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036145385 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.36809 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-45057 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63471 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-40567 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.