| Doctor Name: | MRS. LISA HAWTHORNE |
| NPI Number: | 1275509416 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.N.P. |
| License Number: | F302679-1 |
| Business Practice Address: | 260 Township Blvd Ste 20 Camillus, NY - 130311674 |
| Business Phone Number: | 3157080091 |
| Business Fax Number: | 3157080194 |
| Mailing Address: | 260 Township Blvd, Ste 20 CAMILLUS |
| State: | NY |
| Postal Code: | 130311674 |
| Phone Number: | 3157080091 |
| Fax Number: | 3157080194 |
| NPI Enumeration Date: | 02/27/2006 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F302679-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |