MEDICARE: MARY HELENE HOUSLEY GNP

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	363L00000X	Nurse Practitioner	7669	CA
2	363LG0600X	Gerontology Nurse Practitioner	7669	CA

General Provider Information

NPI Number	:	1508894833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HELENE HOUSLEY GNP

Provider Business Mailing Address
First Line	:	1100 MARSHALL WAY
Second Line	:	TCC
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6533
Country	:	US
Telephone Number	:	530-622-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2288 AUBURN BLVD STE 106
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1619
Country	:	US
Telephone Number	:	916-568-8338
Fax Number	:	916-925-4166

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/21/2022

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