Provider Demographics
NPI:1205130820
Name:JONES, KATHERINE GRACE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRACE
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:GRACE
Other - Last Name:HABERSTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
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 1:1 PILLSBURY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3556
Practice Address - Country:US
Practice Address - Phone:603-224-4776
Practice Address - Fax:603-228-2113
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063727-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30348607Medicaid
NH30348607Medicaid