Healthcare Provider Details

I. General information

NPI: 1093890055
Provider Name (Legal Business Name): CHRISTINA M HAWTHORNE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DE PAUL DR STE 470
BRIDGETON MO
63044-2510
US

IV. Provider business mailing address

12255 DE PAUL DR STE 470
BRIDGETON MO
63044-2510
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-8863
  • Fax: 314-739-6448
Mailing address:
  • Phone: 314-739-8863
  • Fax: 314-739-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: