Healthcare Provider Details

I. General information

NPI: 1306416516
Provider Name (Legal Business Name): FARAH THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 PENNSYLVANIA ST
CARMEL IN
46032-6601
US

IV. Provider business mailing address

12315 PENNSYLVANIA ST
CARMEL IN
46032-6601
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number28255603A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: