Jennifer Christine Hathaway

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

76819 Issued in MN

Practice address

14000 Fairview Dr
Burnsville, MN 55337-5713

Phone

(952) 993-8700

NPI assigned

Apr 21, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904

  Single Specialty

  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593

  Pediatrics

  NPD
• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1245217520

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1124600093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375713",
            "telephone_number": "952-993-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "717 Delaware St SE Ste 353",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554142959",
            "country_code": "US",
            "telephone_number": "612-626-3761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "JENNIFER",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MN",
            "license": "X000-057-306-400",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "76819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Siham Mohamed Hassan
• Warda Mohamed Hassan
• Zahra Hassan
• Zainab Hassan
• Abby L Hatcher
• Signe Grace Hauck
• Jonathan Michael Hauff, DPT
• Havenwood Care LLC
• Havenworth Assisted Living Inc
• Nasri Haybe

• Pediatrics Physician in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.