Healthcare Provider Details

I. General information

NPI: 1821303827
Provider Name (Legal Business Name): CATHERINE RITA FARNAM RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 VIEWRIDGE AVENUE SUITE 230
SAN DEIGO CA
92123-4721
US

IV. Provider business mailing address

4715 VIEWRIDGE AVE STE 230
SAN DIEGO CA
92123-1680
US

V. Phone/Fax

Practice location:
  • Phone: 336-609-1979
  • Fax:
Mailing address:
  • Phone: 336-609-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number161226
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberARNP9395130
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9395130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: