Provider Demographics
NPI:1740442003
Name:HYDE, JANE KATHLEEN (CST CSA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:KATHLEEN
Last Name:HYDE
Suffix:
Gender:F
Credentials:CST CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2506
Mailing Address - Country:US
Mailing Address - Phone:570-336-9278
Mailing Address - Fax:
Practice Address - Street 1:236 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2506
Practice Address - Country:US
Practice Address - Phone:570-336-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3234246ZC0007X
PA96765246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist