Most Relevant Information
Provider Data
NPI Number: | 1003479593 |
Provider Name: | JENCI LYN HAWTHORNE MEDICAL STUDENT, MD |
Entity Type: | Individual |
Taxonomy Code: | 390200000X |
Specialty: | Student in an Organized Health Care Education/Training Program |
License Number: |
Most Important Dates
Enumeration Date: | 04/19/2019 |
Last Updated: | 05/06/2021 |
Provider Practice Location
500 S PRESTON ST RM 305
LOUISVILLE
KY
402021702
Practice Location Phone/Fax
Phone: | 5028528696 |
Fax: |
Provider Mailing Location
550 S JACKSON ST FL 2
LOUISVILLE
KY
402021622
Provider Mailing Phone/Fax
Phone: | 5025617448 |
Fax: |