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General NPI Number Information
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NPI Number | 1689288359
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Entity Type | Individual
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Provider Name | CANDACE KATELYNN FAZENBAKER CRNP-FNP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 96 SOFIA DR
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City | SHREWSBURY
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State | PA
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Zip | 17361-5201
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Country | US
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Telephone | 717-812-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax | 717-851-6969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R213040
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP023229
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License Number State | PA
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