Provider Demographics
NPI:1609209766
Name:HAINER, ANGELA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:HAINER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JAGOUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 BUCKNAM RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1208
Mailing Address - Country:US
Mailing Address - Phone:207-781-1551
Mailing Address - Fax:207-781-1552
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1551
Practice Address - Fax:207-781-1552
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN47011163WR0006X
MECNP131068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant