Provider Demographics
NPI:1811542087
Name:HAUSE, MARTIN MICHAEL
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:MICHAEL
Last Name:HAUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 ARVILLE ST APT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7685
Mailing Address - Country:US
Mailing Address - Phone:702-934-0681
Mailing Address - Fax:
Practice Address - Street 1:3150 ARVILLE ST TRLR 91
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7643
Practice Address - Country:US
Practice Address - Phone:702-934-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide