Healthcare Provider Details

I. General information

NPI: 1881707834
Provider Name (Legal Business Name): COREY FARNUM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 S MAIN ST
CLARION IA
50525-2019
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4847
  • Fax: 402-449-4885
Mailing address:
  • Phone: 515-532-2811
  • Fax: 515-532-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100900
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD143569
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: