MEDICARE: CARISSA HAULMAN

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1639061781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA HAULMAN

Provider Business Mailing Address
First Line	:	254 NININGER RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-4275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150104 SPRING CREEK RD
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-5514
Country	:	US
Telephone Number	:	308-562-5125
Fax Number	:

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

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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Directions to “ CARISSA HAULMAN ” Practice Location

Language	Start Address	Practice Location

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