MEDICARE: MS. DARRA A. HUSOME FNP, CNS

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	363LF0000X	Family Nurse Practitioner	516365	CA

General Provider Information

NPI Number	:	1952444986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARRA A. HUSOME FNP, CNS

Provider Business Mailing Address
First Line	:	21445 CHIPMUNK LN
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96003-8799
Country	:	US
Telephone Number	:	530-549-5778
Fax Number	:

Provider Business Practice Location Address
First Line	:	29632 HIGHWAY 299 EAST
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084
Country	:	US
Telephone Number	:	530-337-6243
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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