Provider Demographics
NPI:1770535221
Name:HASLAM, JANE KATHRYN (CRNA)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:KATHRYN
Last Name:HASLAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:KATHRYN
Other - Last Name:KUCINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:141 N MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2055
Mailing Address - Country:US
Mailing Address - Phone:207-973-4519
Mailing Address - Fax:207-992-4132
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-4519
Practice Address - Fax:207-992-4132
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180425367500000X
MEAA083288367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME225502Medicare PIN
MEME225501Medicare PIN