Healthcare Provider Details

I. General information

NPI: 1316914591
Provider Name (Legal Business Name): SUSAN S. FAGUE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 7TH ST
CHAMBERSBURG PA
17201-1720
US

IV. Provider business mailing address

785 5TH AVE SUITE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7164
  • Fax: 717-267-7414
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-217-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN240958L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: