Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 3504789OH | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35047890 | OH |
N | 208D00000X | General Practice Physician | 35047890 | OH |
NPI | 1104891944 |
---|---|
Provider Name | Dr. Terresa Louise Hawthorne |
First Address | Lancaster, OH 43130-4056 |
Second Address | Lancaster, OH 43130-4056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 13/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0892584 | (05) | OH |
A80789 | (02) |