Healthcare Provider Details

I. General information

NPI: 1669402079
Provider Name (Legal Business Name): ROMAYNE ELIZABETH FARRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROMAYNE ELIZABETH GUSTAFSON

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MEDICAL CENTER DRIVE
ROHNERT PARK CA
94928
US

IV. Provider business mailing address

15620 HEALDSBURG AVENUE
HEALDSBURG CA
95448
US

V. Phone/Fax

Practice location:
  • Phone: 707-586-0440
  • Fax: 707-586-1444
Mailing address:
  • Phone: 707-473-4531
  • Fax: 707-473-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: