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General NPI Number Information
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NPI Number | 1144663337
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Entity Type | Organization
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Legal Business Name | WOMEN'S CENTER OF THE PENINSULA
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 254 N BINKLEY ST
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City | SOLDOTNA
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State | AK
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Zip | 99669-7522
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Country | US
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Telephone | 907-260-2622
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Fax | 907-260-2606
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Provider Business Mailing Address
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Address Line | 254 N BINKLEY ST
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City | SOLDOTNA
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State | AK
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Zip | 99669-7522
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Country | US
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Telephone | 907-260-2622
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Fax | 907-260-2606
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JO LYNN HAWTHORNE
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Credential | MD
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Telephone | 907-260-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 7311
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License Number State | AK
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