Provider Demographics
NPI:1699775080
Name:HAWTHORNE, SHERRI LYNN (NP)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MOUNT PLEASANT AVE
Mailing Address - Street 2:WEST ORANGE
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2724
Mailing Address - Country:US
Mailing Address - Phone:973-731-9442
Mailing Address - Fax:973-731-2918
Practice Address - Street 1:375 MOUNT PLEASANT AVE
Practice Address - Street 2:WEST ORANGE
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2724
Practice Address - Country:US
Practice Address - Phone:973-731-9442
Practice Address - Fax:973-731-2918
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN11075200363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP61930Medicare UPIN
NJ059057Medicare ID - Type Unspecified