Provider Demographics
NPI:1902341431
Name:HAWTHORNE, NICOLETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:ANN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4527 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5352
Mailing Address - Country:US
Mailing Address - Phone:602-845-8000
Mailing Address - Fax:
Practice Address - Street 1:4527 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5352
Practice Address - Country:US
Practice Address - Phone:602-845-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily