Provider Demographics
NPI:1316519325
Name:HATLEVIG, CAMERON RENEE (CRNA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:RENEE
Last Name:HATLEVIG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W MORGAN ST APT 308
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2172
Mailing Address - Country:US
Mailing Address - Phone:678-571-1751
Mailing Address - Fax:
Practice Address - Street 1:604 W MORGAN ST APT 308
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2172
Practice Address - Country:US
Practice Address - Phone:678-571-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222771163WC0200X
NC7309367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN222771OtherRN LICENSURE