MEDICARE: ANNETTE NOEL HASSELBECK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	369774-1	NY

General Provider Information

NPI Number	:	1619938461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE NOEL HASSELBECK CRNA

Provider Business Mailing Address
First Line	:	6011 RAILROAD ST
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9764
Country	:	US
Telephone Number	:	716-741-3076
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 RAILROAD ST
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9764
Country	:	US
Telephone Number	:	716-741-3076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	12/05/2011

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