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NPI Code Detail

MEDICARE: MS. KATRINA MARISA HAUSMAN

MEDICARE: MS. KATRINA MARISA HAUSMAN
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1932643962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATRINA MARISA HAUSMAN
Provider Business Mailing Address
First Line : 866 RETTIG AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89044-9522
Country : US
Telephone Number : 714-624-8896
Fax Number :
Provider Business Practice Location Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2016
Last Update Date : 12/09/2016

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