MEDICARE: MARIE HUSSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	NH053	NC
2	314000000X	Skilled Nursing Facility	NH053	NC

General Provider Information

NPI Number	:	1033640735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE HUSSEY

Provider Business Mailing Address
First Line	:	5701 N FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28360-2163
Country	:	US
Telephone Number	:	910-739-2821
Fax Number	:	910-738-4539

Provider Business Practice Location Address
First Line	:	5701 N FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28360-2163
Country	:	US
Telephone Number	:	910-739-2821
Fax Number	:	910-738-4539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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Directions to “ MARIE HUSSEY ” Practice Location

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