MEDICARE: MRS. REBECCA SUE VAN HASELEN RNFA

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	163WR0006X	Registered Nurse First Assistant	RN43539	NV

General Provider Information

NPI Number	:	1649550583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA SUE VAN HASELEN RNFA

Provider Business Mailing Address
First Line	:	3073 OLIVIA HEIGHTS AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8539
Country	:	US
Telephone Number	:	702-289-2036
Fax Number	:	702-270-2362

Provider Business Practice Location Address
First Line	:	3073 OLIVIA HEIGHTS AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8539
Country	:	US
Telephone Number	:	702-289-2036
Fax Number	:	702-270-2362

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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