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General NPI Number Information
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NPI Number | 1508095399
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Entity Type | Individual
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Provider Name | CARLA KAY HAUSRATH R.N., N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 210 CORNELIA ST SUITE 202
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2318
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Country | US
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Telephone | 518-563-6348
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Fax | 518-563-6378
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Provider Business Mailing Address
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Address Line | 210 CORNELIA ST SUITE 202
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2318
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Country | US
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Telephone | 518-563-6348
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Fax | 518-563-6378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 305178
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 5229711
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License Number State | NY
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