Healthcare Provider Details

I. General information

NPI: 1134368350
Provider Name (Legal Business Name): MARJORY ROBERTSON HAUSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55957 SPRING CREEK RD
BANDON OR
97411-8330
US

IV. Provider business mailing address

55957 SPRING CREEK RD
BANDON OR
97411-8330
US

V. Phone/Fax

Practice location:
  • Phone: 541-347-4050
  • Fax: 541-347-4050
Mailing address:
  • Phone: 541-347-4050
  • Fax: 541-347-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200842738RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: