Provider Demographics
NPI:1508095399
Name:HAUSRATH, CARLA KAY (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:KAY
Last Name:HAUSRATH
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:KAY
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R N
Mailing Address - Street 1:210 CORNELIA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2318
Mailing Address - Country:US
Mailing Address - Phone:518-563-6348
Mailing Address - Fax:518-563-6378
Practice Address - Street 1:210 CORNELIA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2318
Practice Address - Country:US
Practice Address - Phone:518-563-6348
Practice Address - Fax:518-563-6378
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305178363LA2200X
NY5229711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse