Provider Demographics
NPI:1386296242
Name:HATHEWAY, JOSEPH HARNETT (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HARNETT
Last Name:HATHEWAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3361
Mailing Address - Country:US
Mailing Address - Phone:207-475-7162
Mailing Address - Fax:707-824-9335
Practice Address - Street 1:568 LIVE OAK AVE STE H
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3361
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:707-869-8170
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily