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NPI Code Detail

MEDICARE: NINA HATHAWAY

MEDICARE: NINA HATHAWAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse4703089945MI

General Provider Information

NPI Number : 1881016319
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA HATHAWAY
Provider Business Mailing Address
First Line : 4205 E TOWNLINE LAKE RD
Second Line :
City : HARRISON
State : MI
Zip : 48625-9240
Country : US
Telephone Number : 989-630-0019
Fax Number :
Provider Business Practice Location Address
First Line : 209 E CHIPPEWA ST
Second Line :
City : MT PLEASANT
State : MI
Zip : 48858-1609
Country : US
Telephone Number : 989-772-1261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 01/17/2014

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Directions to “ NINA HATHAWAY ” Practice Location

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