Healthcare Provider Details

I. General information

NPI: 1770813867
Provider Name (Legal Business Name): DAVID HUDSPATH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MEMORIAL DR
FARRELL PA
16121-1357
US

IV. Provider business mailing address

1601 MOTOR INN DR SUITE 310
GIRARD OH
44420-2420
US

V. Phone/Fax

Practice location:
  • Phone: 724-824-4096
  • Fax: 724-269-9476
Mailing address:
  • Phone: 724-824-4096
  • Fax: 724-269-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN573676
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: