Provider Demographics
NPI:1619215589
Name:HABERSTRO, VERANIKA R (CRNA)
Entity Type:Individual
Prefix:
First Name:VERANIKA
Middle Name:R
Last Name:HABERSTRO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VERANIKA
Other - Middle Name:R
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PILLSBURY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3556
Mailing Address - Country:US
Mailing Address - Phone:603-224-4776
Mailing Address - Fax:603-228-2113
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-224-4776
Practice Address - Fax:603-228-2113
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH055066-23367500000X
TXAP125183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH33400341Medicaid
NH003129201Medicare PIN