Provider Demographics
NPI:1477055218
Name:HAUSFELD, KATELYN MARIE (PNP-AC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:HAUSFELD
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1812
Mailing Address - Country:US
Mailing Address - Phone:513-708-9163
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD.
Practice Address - Street 2:PO BOX 3046
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-681-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010353363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care