Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000559 | MO |
NPI | 1093890055 |
---|---|
Provider Name | Christina M Hawthorne |
First Address | Bridgeton, MO 63044-2510 |
Second Address | Bridgeton, MO 63044-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1984900 | CIGNA (01) | MO |
2700497 | UHC (01) | MO |
303231500 | (05) | MO |
49331 | BLUE CROSS (01) | MO |
CK3051 | RR MEDICARE (01) | MO |
T86408 | (02) | MO |