Provider Demographics
NPI:1568436814
Name:FAUCHER, DEBRA (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:FAUCHER
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 1:11 HIGHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2459
Mailing Address - Country:US
Mailing Address - Phone:814-362-0103
Mailing Address - Fax:
Practice Address - Street 1:ERPG CRNA SERVICES
Practice Address - Street 2:763 JOHNSONBURG ROAD
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-788-8569
Practice Address - Fax:814-788-8092
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN340462L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053130OtherCRNA CERTIFICATE
055876Medicare ID - Type Unspecified