Provider Demographics
NPI:1891410726
Name:FAHRNBACH, JUSTYNE PAYGE
Entity Type:Individual
Prefix:
First Name:JUSTYNE
Middle Name:PAYGE
Last Name:FAHRNBACH
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 1:14311 UPPER CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9540
Mailing Address - Country:US
Mailing Address - Phone:937-822-1737
Mailing Address - Fax:
Practice Address - Street 1:14311 UPPER CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9540
Practice Address - Country:US
Practice Address - Phone:937-822-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion