Individual
JESYCA R HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1601 SIOUX VALLEY DR, LUVERNE, MN 56156-4500
(507) 283-4476
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
CR000789
SD
367500000X
Certified Registered Nurse Anesthetist
Primary
D163533
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902166259
WELLMARK BCBS SD
—
05
—
1902166259
—
MN
05
—
1902166259
—
SD
05
—
46022474348
—
NE
01
—
P01103855
RAILROAD MEDICARE
SD
Enumeration date
05/21/2012
Last updated
05/19/2022
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