Basic Information
| Provider Information | |||||||||
| NPI: | 1568436814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUCHER | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 HIGHWOOD LN | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167012459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143620103 | ||||||||
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| Practice Location | |||||||||
| Address1: | ERPG CRNA SERVICES | ||||||||
| Address2: | 763 JOHNSONBURG ROAD | ||||||||
| City: | ST. MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888569 | ||||||||
| FaxNumber: | 8147888092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN340462L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 053130 | 01 | PA | CRNA CERTIFICATE | OTHER |