MEDICARE: VICTORIA FAUST CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	425695	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8X1705	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316943509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA FAUST CNS

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:	214-590-4105
Fax Number	:	214-590-4162

Provider Business Practice Location Address
First Line	:	5201 HARRY HINES BLVD
Second Line	:	MEDICAL STAFF SERVICES
City	:	DALLAS
State	:	TX
Zip	:	75235-7708
Country	:	US
Telephone Number	:	214-590-8006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/14/2007

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