Provider Demographics
NPI:1609180314
Name:HAUSLER, JESSICA AIKO (PA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:AIKO
Last Name:HAUSLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 CENTURY HILL DR
Mailing Address - Street 2:CENTER FOR FAMILY PRACTICE
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-783-7173
Mailing Address - Fax:518-783-5426
Practice Address - Street 1:8 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-783-7173
Practice Address - Fax:518-783-5426
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
NYPENDINGMedicare PIN