MEDICARE: SHAYNE HAUGLUM 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	048592311	NH
2	367500000X	Certified Registered Nurse Anesthetist	APRN9336042	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010732448	OTHER	NH	TRICARE WHITE MTN ANESTH.
2	NI1211	OTHER	NH	ACS INDIVIDUAL
3	NI1207	OTHER	NH	ACS WHITE MTN ANESTHESIA
4	276054	OTHER	NH	HARVARD INDIVIDUAL
5	40Y003831NH01	OTHER	NH	ANTHEM INDIVIDUAL
6	693984	OTHER	NH	TUFTS INDIVIDUAL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	50Y152300MA01	OTHER	NH	ANTHEM WHITE MTN ANESTH.

General Provider Information

NPI Number	:	1821087685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYNE HAUGLUM CRNA

Provider Business Mailing Address
First Line	:	1611 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1005
Country	:	US
Telephone Number	:	305-585-6586
Fax Number	:	305-585-5830

Provider Business Practice Location Address
First Line	:	3073 WHITE MOUNTAIN HWY
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5111
Country	:	US
Telephone Number	:	603-356-5461
Fax Number	:	603-356-7651

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	01/19/2024

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