Provider Demographics
NPI:1821087685
Name:HAUGLUM, SHAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:
Last Name:HAUGLUM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-6586
Mailing Address - Fax:305-585-5830
Practice Address - Street 1:3073 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5111
Practice Address - Country:US
Practice Address - Phone:603-356-5461
Practice Address - Fax:603-356-7651
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048592311367500000X
FLAPRN9336042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH010732448OtherTRICARE WHITE MTN ANESTH.
NHNI1211OtherACS INDIVIDUAL
NHNI1207OtherACS WHITE MTN ANESTHESIA
NH276054OtherHARVARD INDIVIDUAL
NH40Y003831NH01OtherANTHEM INDIVIDUAL
NH693984OtherTUFTS INDIVIDUAL
ME135830000Medicaid
NH30342370Medicaid
ME237640099Medicaid
NH50Y152300MA01OtherANTHEM WHITE MTN ANESTH.