Provider Demographics
NPI:1144503665
Name:FAZIO, CLARENDA VENAE
Entity type:Individual
Prefix:
First Name:CLARENDA
Middle Name:VENAE
Last Name:FAZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EAST ST
Mailing Address - Street 2:
Mailing Address - City:N LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060
Mailing Address - Country:US
Mailing Address - Phone:614-309-9921
Mailing Address - Fax:
Practice Address - Street 1:119 EAST ST
Practice Address - Street 2:
Practice Address - City:N LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060
Practice Address - Country:US
Practice Address - Phone:614-309-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker