Healthcare Provider Details

I. General information

NPI: 1508894833
Provider Name (Legal Business Name): MARY HELENE HOUSLEY GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY HELENE NAMESNIK GNP

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 AUBURN BLVD STE 106
SACRAMENTO CA
95821-1619
US

IV. Provider business mailing address

1100 MARSHALL WAY TCC
PLACERVILLE CA
95667-6533
US

V. Phone/Fax

Practice location:
  • Phone: 916-568-8338
  • Fax: 916-925-4166
Mailing address:
  • Phone: 530-622-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7669
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number7669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: