Healthcare Provider Details

I. General information

NPI: 1831154590
Provider Name (Legal Business Name): REBECCA FARNSWORTH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST. SUITE K3502
BUFFALO NY
14203
US

IV. Provider business mailing address

1001 MAIN ST. SUITE K3502
BUFFALO NY
14203
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3268
  • Fax: 814-375-3384
Mailing address:
  • Phone: 315-339-1959
  • Fax: 315-339-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number541218
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN295835L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: