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General NPI Number Information
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NPI Number | 1437476538
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Entity Type | Organization
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Legal Business Name | KRIS H WUSTERHAUSEN DO PA
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 747 S SUGARTREE DR
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City | LIPAN
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State | TX
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Zip | 76462-4328
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Country | US
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Telephone | 817-845-8322
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Fax |
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Provider Business Mailing Address
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Address Line | 747 S SUGARTREE DR
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City | LIPAN
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State | TX
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Zip | 76462-4328
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Country | US
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Telephone | 817-845-8322
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KRIS H WUSTERHAUSEN
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Credential | D.O.
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Telephone | 817-845-8322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | K8703
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License Number State | TX
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