Provider Demographics
NPI:1841734373
Name:HOUSLEY, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HOUSLEY
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:PO BOX 236
Mailing Address - Street 2:14361 HWY 128
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415-0236
Mailing Address - Country:US
Mailing Address - Phone:707-895-2641
Mailing Address - Fax:
Practice Address - Street 1:14361 HWY 128
Practice Address - Street 2:236
Practice Address - City:BOONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95415-0236
Practice Address - Country:US
Practice Address - Phone:707-895-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6528142172A00000X
CAB3619876172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver