Basic Information
| Provider Information | |||||||||
| NPI: | 1821087685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUGLUM | ||||||||
| FirstName: | SHAYNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2161 | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038602161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
| FaxNumber: | 6033567651 | ||||||||
| Practice Location | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038605111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
| FaxNumber: | 6033567651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 276054 | 01 | NH | HARVARD INDIVIDUAL | OTHER | 693984 | 01 | NH | TUFTS INDIVIDUAL | OTHER | 50Y152300MA01 | 01 | NH | ANTHEM WHITE MTN ANESTH. | OTHER | NI1211 | 01 | NH | ACS INDIVIDUAL | OTHER | 40Y003831NH01 | 01 | NH | ANTHEM INDIVIDUAL | OTHER | NI1207 | 01 | NH | ACS WHITE MTN ANESTHESIA | OTHER | 30342370 | 05 | NH | MEDICAID |