Provider Demographics
NPI:1255725768
Name:HAUSNER, BOBIE JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:BOBIE
Middle Name:JEAN
Last Name:HAUSNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 PICKETTS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:NY
Mailing Address - Zip Code:12981-3428
Mailing Address - Country:US
Mailing Address - Phone:518-572-9773
Mailing Address - Fax:518-572-9773
Practice Address - Street 1:537 PICKETTS CORNERS RD
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:NY
Practice Address - Zip Code:12981-3428
Practice Address - Country:US
Practice Address - Phone:518-572-9773
Practice Address - Fax:518-572-9773
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262918-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse