Provider Demographics
NPI:1952366205
Name:FARABAUGH, CLEMENT (CRNA)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:
Last Name:FARABAUGH
Suffix:
Gender:M
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0108
Mailing Address - Country:US
Mailing Address - Phone:814-696-8886
Mailing Address - Fax:814-696-8883
Practice Address - Street 1:3109 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4475
Practice Address - Country:US
Practice Address - Phone:814-696-8886
Practice Address - Fax:814-696-8883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN266678L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA763209OtherHIGHMARK
PAS15283Medicare UPIN
PA763209OtherHIGHMARK