MEDICARE: MS. KAREN GRACE HAUSTEEN 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	RN031338	AZ
2	163WR0006X	Registered Nurse First Assistant	250417	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN031338	OTHER	AZ	RN
2	250417	OTHER	CA	RN

General Provider Information

NPI Number	:	1912009663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN GRACE HAUSTEEN RNFA

Provider Business Mailing Address
First Line	:	PO BOX 22212
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-0212
Country	:	US
Telephone Number	:	760-898-6641
Fax Number	:

Provider Business Practice Location Address
First Line	:	13252 N 38TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-6608
Country	:	US
Telephone Number	:	602-441-0250
Fax Number	:	602-441-0250

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	11/21/2017

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