Provider Demographics
NPI:1417030784
Name:SPINA, KATE W (CRNA)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:W
Last Name:SPINA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:W
Other - Last Name:MYERSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:375 ENGLE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1823
Mailing Address - Country:US
Mailing Address - Phone:201-871-6073
Mailing Address - Fax:201-655-6159
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-871-6073
Practice Address - Fax:201-655-6159
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11755500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00402023OtherRAILROAD MEDICARE
NJ106461A8SMedicare PIN