Healthcare Provider Details

I. General information

NPI: 1962590430
Provider Name (Legal Business Name): CATHERINE P HAGERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STEVENS AVE MSNA, UNE
PORTLAND ME
04103-2656
US

IV. Provider business mailing address

3 BARLEY LN
SCARBOROUGH ME
04074-8442
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-2400
  • Fax:
Mailing address:
  • Phone: 207-883-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number022890
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: