MEDICARE: RENEE NICOLE FARAG CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	050344200311E	AR

General Provider Information

NPI Number	:	1093132409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE NICOLE FARAG CNA

Provider Business Mailing Address
First Line	:	132 SADDLEBACK LANE
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22602
Country	:	US
Telephone Number	:	870-310-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 COW LANE
Second Line	:
City	:	JUNCTION CITY
State	:	AR
Zip	:	71749
Country	:	US
Telephone Number	:	870-310-7406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	03/24/2014

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