Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 024326-1 | NY |
NPI | 1750689899 |
---|---|
Provider Name | Crystal Joanne Hawthorne |
First Address | Bronx, NY 10456-2750 |
Second Address | Bronx, NY 10456-2750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2011 |
Last Update Date | 12/03/2011 |