Healthcare Provider Details

I. General information

NPI: 1316170335
Provider Name (Legal Business Name): WENDY FARNSWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8766 E. HWY 69 C/O DONNA THAXTON HUMBOLDT UNIFIED SCHOOL DISTRICT/SSO
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

8766 E. HWY 69 C/O DONNA THAXTON HUMBOLDT UNIFIED SCHOOL DISTRICT/SSO
PRESCOTT VALLEY AZ
86314
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-4042
  • Fax: 928-759-4030
Mailing address:
  • Phone: 928-759-4042
  • Fax: 928-759-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN088057
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: