Basic Information
| Provider Information | |||||||||
| NPI: | 1508894833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSLEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | HELENE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | GNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NAMESNIK | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | HELENE | ||||||||
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| OtherCredential: | GNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 MARSHALL WAY | ||||||||
| Address2: | TCC | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956676533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306221441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2288 AUBURN BLVD STE 106 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958211619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165688338 | ||||||||
| FaxNumber: | 9169254166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 7669 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | 7669 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.