Provider Demographics
NPI:1295731818
Name:HAWTHORNE, DOLORES R (FNP)
Entity type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:R
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-0046
Mailing Address - Country:US
Mailing Address - Phone:318-766-1967
Mailing Address - Fax:318-766-9090
Practice Address - Street 1:1115 LEVEE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:LA
Practice Address - Zip Code:71366-6639
Practice Address - Country:US
Practice Address - Phone:318-766-1967
Practice Address - Fax:318-766-9090
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082557 AP04477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H379Medicare ID - Type Unspecified
LAQ40696Medicare UPIN