Healthcare Provider Details

I. General information

NPI: 1578205688
Provider Name (Legal Business Name): CINDY HAGA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROANE ST
CHARLESTON WV
25302-2334
US

IV. Provider business mailing address

706 PLANTATION DR
HURRICANE WV
25526-9155
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0096
  • Fax:
Mailing address:
  • Phone: 304-880-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116904
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: