Healthcare Provider Details

I. General information

NPI: 1912009663
Provider Name (Legal Business Name): KAREN GRACE HAUSTEEN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13252 N 38TH PL
PHOENIX AZ
85032-6608
US

IV. Provider business mailing address

PO BOX 22212
PHOENIX AZ
85028-0212
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-0250
  • Fax: 602-441-0250
Mailing address:
  • Phone: 760-898-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN031338
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number250417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: