Individual
SUSAN BRIDGET FAVORITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
169 MARTIN AVE, EPHRATA, PA 17522-1724
(717) 738-6618
Mailing address
220 E 2ND AVE, LITITZ, PA 17543-2024
(717) 627-4431
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
071093
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN302905L
RN LICENSE
PA
Enumeration date
10/11/2006
Last updated
07/08/2007
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