=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871031245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE HAWXHURST PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2017
-----------------------------------------------------
Last Update Date | 08/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 WHITE ST STE 101
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04841-2979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-301-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 CLIFFWOOD TER
-----------------------------------------------------
City | EAST RUTHERFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07073-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-232-3282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00424200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------