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NPI Code Detail

MEDICARE: LAURIE J. FARRELL PA-C

MEDICARE: LAURIE J. FARRELL PA-C
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
1363A00000XPhysician Assistant085000869IL
2363AS0400XSurgical Physician Assistant085000869IL

General Provider Information

NPI Number : 1588792782
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE J. FARRELL PA-C
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-2040
Fax Number : 847-733-5315
Provider Business Practice Location Address
First Line : 2650 RIDGE AVE # 2507
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-1271
Fax Number : 847-570-2930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 03/23/2026

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Directions to “ LAURIE J. FARRELL PA-C” Practice Location

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