Provider Demographics
NPI: | 1629696604 |
---|---|
Name: | FAUST, HELGA (CRNP, FNP - C) |
Entity Type: | Individual |
Prefix: | |
First Name: | HELGA |
Middle Name: | |
Last Name: | FAUST |
Suffix: | |
Gender: | F |
Credentials: | CRNP, FNP - C |
Other - Prefix: | |
Other - First Name: | KATE |
Other - Middle Name: | |
Other - Last Name: | FAUST |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | CRNP, NP - C |
Mailing Address - Street 1: | 100 N ACADEMY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DANVILLE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17822-4903 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 570-271-6144 |
Mailing Address - Fax: | 570-271-6578 |
Practice Address - Street 1: | 385 STATE ST |
Practice Address - Street 2: | |
Practice Address - City: | SUNBURY |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17801-2531 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-286-6773 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2020-07-07 |
Last Update Date: | 2020-11-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | SP022111 | 363LP2300X, 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | SP022111 | Other | CRNP |