Provider Demographics
NPI:1508894833
Name:HOUSLEY, MARY HELENE (GNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELENE
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HELENE
Other - Last Name:NAMESNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:1100 MARSHALL WAY
Mailing Address - Street 2:TCC
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6533
Mailing Address - Country:US
Mailing Address - Phone:530-622-1441
Mailing Address - Fax:
Practice Address - Street 1:2288 AUBURN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1619
Practice Address - Country:US
Practice Address - Phone:916-568-8338
Practice Address - Fax:916-925-4166
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7669363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77290Medicare UPIN