Provider Demographics
NPI:1407356629
Name:HAINES-ANSHUTZ, CATHY M
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:M
Last Name:HAINES-ANSHUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 N HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4151
Mailing Address - Country:US
Mailing Address - Phone:702-630-1174
Mailing Address - Fax:702-293-3664
Practice Address - Street 1:800 N RAINBOW BLVD STE 212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-293-3888
Practice Address - Fax:702-293-3664
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV372500000X, 376J00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid