Healthcare Provider Details

I. General information

NPI: 1336640150
Provider Name (Legal Business Name): ELISSA ANN HAUSSLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

PO BOX 218
WAVERLY NE
68462-0218
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1000
  • Fax:
Mailing address:
  • Phone: 303-404-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number0186948
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: