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General NPI Number Information
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NPI Number | 1790580686
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Entity Type | Individual
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Provider Name | MARY KATHERINE HAVERBUSCH APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2025
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 2139 AUBURN AVE
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City | CINCINNATI
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State | OH
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Zip | 45219-2989
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Country | US
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Telephone | 513-585-2062
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Fax |
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Provider Business Mailing Address
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Address Line | 8037 ARCADIA BLVD
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City | ALEXANDRIA
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State | KY
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Zip | 41001-1486
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Country | US
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Telephone |
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0037707
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4010708
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License Number State | KY
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