Healthcare Provider Details

I. General information

NPI: 1992112023
Provider Name (Legal Business Name): CHRISTINE LOUISE FAHR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 WARD DR
CLAYSBURG PA
16625-8219
US

IV. Provider business mailing address

365 WARD DR
CLAYSBURG PA
16625-8219
US

V. Phone/Fax

Practice location:
  • Phone: 814-239-2211
  • Fax: 814-239-8116
Mailing address:
  • Phone: 814-239-2211
  • Fax: 814-239-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP 013983
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: